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

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By Michael Price Expensive medications tend to make us feel better, even when they’re no different than cheap generics. But they can also make us feel worse, according to a new study. Researchers have found that we’re more likely to experience negative side effects when we take a drug we think is pricier—a flip side of the placebo effect known as the “nocebo” effect. The work could help doctors decide whether to recommend brand-name or generic drugs depending on each patient’s expectations. In the study, researchers asked 49 people to test out a purported anti-itch cream that, in reality, contained no active ingredient. Some got “Solestan® Creme,” a fake brand name in a sleek blue box designed to look like other expensive brands on the market. Others received “Imotadil-LeniPharma Creme”—another fake, this time housed in a chintzier orange box resembling those typically used for generic drugs. “I put a lot of effort into making the designs convincing,” says study leader Alexandra Tinnermann, a neuroscientist at University Medical Center Hamburg-Eppendorf in Germany. The researchers rubbed one of the two creams on the volunteers’ forearms and waited a few minutes for it soak in. They told the participants that the cream could cause increased sensitivity to pain—a known side effect of real medications called hyperalgesia. Then the scientists affixed a small device to the volunteers’ arms that delivered a brief flash of heat up to about 45°C (or 113°F). © 2017 American Association for the Advancement of Science.

Keyword: Pain & Touch
Link ID: 24154 - Posted: 10.06.2017

By JANE E. BRODY If you’ve never had a migraine, I have two things to say to you: 1) You’re damn lucky. 2) You can’t begin to imagine how awful they are. I had migraines – three times a month, each lasting three days — starting from age 11 and finally ending at menopause. Although my migraines were not nearly as bad as those that afflict many other people, they took a toll on my work, family life and recreation. Atypically, they were not accompanied by nausea or neck pain, nor did I always have to retreat to a dark, soundless room and lie motionless until they abated. But they were not just “bad headaches” — the pain was life-disrupting, forcing me to remain as still as possible. Despite being the seventh leading cause of time spent disabled worldwide, migraine “has received relatively little attention as a major public health issue,” Dr. Andrew Charles, a California neurologist, wrote recently in The New England Journal of Medicine. It can begin in childhood, becoming more common in adolescence and peaking in prevalence at ages 35 to 39. It afflicts two to three times more women than men, and one woman in 25 has chronic migraines on more than 15 days a month. But while the focus has long been on head pain, migraines are not just pains in the head. They are a body-wide disorder that recent research has shown results from “an abnormal state of the nervous system involving multiple parts of the brain,” said Dr. Charles, of the U.C.L.A. Goldberg Migraine Program at the David Geffen School of Medicine in Los Angeles. He told me he hoped the journal article would educate practicing physicians, who learn little about migraines in medical school. Before it was possible to study brain function through a functional M.R.I. or PET scan, migraines were thought to be caused by swollen, throbbing blood vessels in the scalp, usually – though not always — affecting one side of the head. This classic migraine symptom prompted the use of medications that narrow blood vessels, drugs that help only some patients and are not safe for people with underlying heart disease. © 2017 The New York Times Company

Keyword: Pain & Touch
Link ID: 24072 - Posted: 09.18.2017

Mariah Quintanilla Kenneth Catania knows just how much it hurts to be zapped by an electric eel. For the first time, the biologist at Vanderbilt University in Nashville has measured the strength of a defensive electrical attack on a real-life potential predator — himself. Catania placed his arm in a tank with a 40-centimeter-long electric eel (relatively small as eels go) and determined, in amperes, the electrical current that flowed into him when the eel struck. At its peak, the current reached 40 to 50 milliamperes in his arm, he reports online September 14 in Current Biology. This zap was painful enough to cause him to jerk his hand from the tank during each trial. “If you’ve ever been on a farm and touched an electric fence, it’s pretty similar to that,” he says. This is Catania’s latest study in a body of research analyzing the intricacies of an electric eel’s behavior. The way electric eels have been described by biologists in the past has been fairly primitive, says Jason Gallant, a biologist who heads the Michigan State University Electric Fish Lab in East Lansing who was not involved in the study. Catania’s work reveals that “what the electric eel is doing is taking the electric ability that it has and using that to its absolute advantage in a very sophisticated, deliberate way,” he says. Electric eels use electric current to navigate, communicate and hunt for small prey. But when faced with a large land-based predator, eels will launch themselves from the water and electrify the animal with a touch of the head. |© Society for Science & the Public 2000 - 2017.

Keyword: Aggression
Link ID: 24068 - Posted: 09.15.2017

By JANE E. BRODY Many years ago I was plagued with debilitating headaches associated with a number of seemingly unrelated activities that included cooking for company and sewing drapes for the house. I thought I might be allergic to natural gas or certain fabrics until one day I realized that I tensed my facial muscles when I concentrated intently on a project. The cure was surprisingly simple: I became aware of how my body was reacting and changed it through self-induced behavior modification. I consciously relaxed my muscles whenever I focused on a task that could precipitate a tension-induced headache. Fast-forward about five decades: Now it was my back that ached when I hurriedly cooked even a simple meal. And once again, after months of pain, I realized that I was transferring stress to the muscles of my back and had to learn to relax them, and to allow more time to complete a project to mitigate the stress. Happy to report, I recently prepared dinner for eight with nary a pain. I don’t mean to suggest that every ache and pain can be cured by self-awareness and changing one’s behavior. But recent research has demonstrated that the mind – along with other nonpharmacological remedies — can be powerful medicine to relieve many kinds of chronic or recurrent pains, especially low back pain. As Dr. James Campbell, a neurosurgeon and pain specialist, put it, “The best treatment for pain is right under our noses.” He suggests not “catastrophizing” – not assuming that the pain represents something disastrous that keeps you from leading the life you’ve chosen. Acute pain is nature’s warning signal that something is wrong that should be attended to. Chronic pain, however, is no longer a useful warning signal, yet it can lead to perpetual suffering if people remain afraid of it, the doctor said. © 2017 The New York Times Company

Keyword: Pain & Touch
Link ID: 24053 - Posted: 09.11.2017

By Matt Reynolds Putting on a brave face won’t fool this algorithm. A new system that rates how much pain someone is in just by looking at their face could help doctors decide how to treat patients. By examining tiny facial expressions and calibrating the system to each person, it provides a level of objectivity in an area where that’s normally hard to come by. “These metrics might be useful in determining real pain from faked pain,” says Jeffrey Cohn at the University of Pittsburgh in the US. The system could make the difference between prescribing potentially addictive painkillers and catching out a faker. Objectively measuring pain levels is a tricky task, says Dianbo Liu, who created the system with his colleagues at the Massachusetts Institute of Technology. People experience and express pain differently, so a doctor’s estimate of a patient’s pain can often differ from a self-reported pain score. In an attempt to introduce some objectivity, Liu and his team trained an algorithm on videos of people wincing and grimacing in pain. Each video consisted of a person with shoulder pain, who had been asked to perform a different movement and then rate their pain levels. The result was an algorithm that can use subtle differences in facial expressions to inform a guess about how a given person is feeling. Certain parts of the face are particularly revealing, says Liu. Large amounts of movement around the nose and mouth tended to suggest higher self-reported pain scores. © Copyright New Scientist Ltd.

Keyword: Pain & Touch; Emotions
Link ID: 24026 - Posted: 09.02.2017

Andrea Hsu Dan Fabbio was 25 and working on a master's degree in music education when he stopped being able to hear music in stereo. Music no longer felt the same to him. When he was diagnosed with a brain tumor, he immediately worried about cancer. Fortunately, his tumor was benign. Unfortunately, it was located in a part of the brain known to be active when people listen to and make music. Fabbio told his surgeon that music was the most important thing is his life. It was his passion as well as his profession. His surgeon understood. He's someone whose passion has been mapping the brain so he can help patients retain as much function as possible. Dr. Web Pilcher, chair of the Department of Neurosurgery at the University of Rochester Medical Center, and his colleague Brad Mahon, a cognitive neuroscientist, had developed a brain mapping program. Since 2011, they've used the program to treat all kinds of patients with brain tumors: mathematicians, lawyers, a bus driver, a furniture maker. Fabbio was their first musician. The idea behind the program is to learn as much as possible about the patient's life and the patient's brain before surgery to minimize damage to it during the procedure. "Removing a tumor from the brain can have significant consequences depending upon its location," Pilcher says. "Both the tumor itself and the operation to remove it can damage tissue and disrupt communication between different parts of the brain." © 2017 npr

Keyword: Hearing; Pain & Touch
Link ID: 24002 - Posted: 08.26.2017

Laurel Hamers Scientists have traced the sensation of itch to a place you can’t scratch. The discomfort of a mosquito bite or an allergic reaction activates itch-sensitive nerve cells in the spinal cord. Those neurons talk to a structure near the base of the brain called the parabrachial nucleus, researchers report in the Aug. 18 Science. It’s a region that’s known to receive information about other sensations, such as pain and taste. The discovery gets researchers one step closer to finding out where itch signals ultimately end up. “The parabrachial nucleus is just the first relay center for [itch signals] going into the brain,” says study coauthor Yan-Gang Sun, a neuroscientist at the Chinese Academy of Sciences in Shanghai. Understanding the way these signals are processed by the brain could someday provide relief for people with chronic itch, Sun says. While the temporary itchiness of a bug bite is annoying, longer term, “uncontrollable scratching behavior can cause serious skin damage.” Previous studies have looked at the way an itch registers on the skin or how neurons convey those sensations to the spinal cord. But how those signals travel to the brain has been a trickier question, and this research is a “major step” toward answering it, says Zhou-Feng Chen, director of the Center for the Study of Itch at Washington University School of Medicine in St. Louis. |© Society for Science & the Public 2000 - 2017.

Keyword: Pain & Touch
Link ID: 23972 - Posted: 08.18.2017

Researchers from the National Institutes of Health have identified a class of sensory neurons (nerve cells that electrically send and receive messages between the body and brain) that can be activated by stimuli as precise as the pulling of a single hair. Understanding basic mechanisms underlying these different types of responses will be an important step toward the rational design of new approaches to pain therapy. The findings were published in the journal Neuron. “Scientists know that distinct types of neurons detect different types of sensations, such as touch, heat, cold, pain, pressure, and vibration,” noted Alexander Chesler, Ph.D., lead author of the study and principal investigator with the National Center for Complementary and Integrative Health’s (NCCIH) Division of Intramural Research (DIR). “But they know more about neurons involved with temperature and touch than those underlying mechanical pain, like anatomical pain related to specific postures or activities.” In this study, Chesler and his colleagues used a novel strategy that combined functional imaging (which measures neuronal activity), recordings of electrical activity in the brain, and genetics to see how neurons respond to various stimuli. The scientists focused on a class of sensory neurons that express a gene called Calca, as these neurons have a long history in pain research. The scientists applied various stimuli to the hairy skin of mice cheeks, including gentle mechanical stimuli (air puff, stroking, and brushing), “high-threshold” mechanical stimuli (hair pulling and skin pinching), and temperature stimulation. They found that the target neurons belong to two broad categories, both of which were insensitive to gentle stimulation. The first was a well-known type of pain fiber—a polymodal nociceptor—that responds to a host of high intensity stimuli such as heat and pinching. The second was a unique and previously unknown type of neuron that responded robustly to hair pulling. They called this previously undescribed class of high-threshold mechanoreceptors (HTMRs) “circ-HTMRs,” due to the unusual nerve terminals these neurons made in skin. They observed that the endings of the fibers made lasso-like structures around the base of each hair follicle.

Keyword: Pain & Touch
Link ID: 23970 - Posted: 08.17.2017

By DAVID C. ROBERTS Five years ago, I still lived a double life. I was 35, looking out over the Gulf of Thailand and a few weathered beach tenders. Inside, where dark suits filled the conference room, I could feel the eyes of my fellow diplomats. No doubt they were wondering why I was sitting on my briefcase. I joked to no one in particular “My nuclear codes,” trying to deflect awkwardness. The case actually concealed an orthotic sitting cushion that muffled the pain in my lower back; without it, silent shrieking was all I heard. Or maybe they had noticed I was the only one sweating. The air-conditioning tempered the tropical heat, but it was no match for the corset heat wrap that lay discreetly under my tailored suit. Over the previous decade I had become adept at hiding the unexplained pain that racked my back and joints. To all appearances, I was a fit 6-foot-3 man with an easy gait. No one in that conference room knew my suit pants disguised a lace-up ankle brace and a strap velcroed around my left knee. Nor did they know that during breaks I would sneak back to my hotel room where my wife, an artist who moonlighted as my one-person pit crew, waited to press my quadratus lumborum muscle back into submission. I lasted through that meeting as I had through countless others. But in the months that followed, sitting and walking became increasingly difficult. I started to stand during meetings, avoid plane travel, and take motorcycle taxis to go just a couple of buildings’ distance. Eventually, I let the doctors at the embassy in on my secret. They deemed me unfit for work and medevac’ed me from Bangkok back to the United States for treatment. I left quickly, without awkward explanations or goodbyes. © 2017 The New York Times Company

Keyword: Pain & Touch
Link ID: 23908 - Posted: 08.02.2017

Ashlie Stevens Ah, the brain freeze — the signature pain of summer experienced by anyone who has eaten an ice cream cone with too much enthusiasm or slurped down a slushie a little too quickly. But have you ever stopped mid-freeze to think about why our bodies react like this? Well, researchers who study pain have, and some, like Dr. Kris Rau of the University of Louisville in Kentucky, say it's a good way to understand the basics of how we process damaging stimuli. But first, a lesson in terminology. "There's a scientific medical term for ice cream headaches which is sphenopalatine ganglion neuralgia," Rau says. Try breaking that out at your next ice cream social. Anyway, to understand how brain freeze happens, it helps to think of your body and brain as a big computer where everything is hooked together. In this case, you see an ice cream truck. You get some ice cream. And then your brain gives you the go-ahead and you dive face-first into a double-scoop of mint chocolate chip. "Now on the roof of your mouth there are a lot of little blood vessels, capillaries," Rau says. "And there's a lot of nerve fibers called nociceptors that detect painful or noxious stimuli." The rush of cold causes those vessels to constrict. "And when that happens, it happens so quickly that all of those little pain fibers in the roof of your mouth — they interpret that as being a painful stimulus," Rau says. A message is then shot up to your brain via the trigeminal nerve, one of the major nerves of the facial area. The brain itself doesn't have any pain sensing fibers, but its covering — called the meninges — does. © 2017 npr

Keyword: Pain & Touch
Link ID: 23901 - Posted: 08.01.2017

By Natalie Grover (Reuters) - A handful of drugmakers are taking their first steps toward developing marijuana-based painkillers, alternatives to opioids that have led to widespread abuse and caused the U.S. health regulator to ask for a withdrawal of a popular drug this month. The cannabis plant has been used for decades to manage pain and there are increasingly sophisticated marijuana products available across 29 U.S. states, as well as in the District of Columbia, where medical marijuana is legal. There are no U.S. Food and Drug Administration (FDA)-approved painkillers derived from marijuana, but companies such as Axim Biotechnologies Inc, Nemus Bioscience Inc and Intec Pharma Ltd have drugs in various stages of development. The companies are targeting the more than 100 million Americans who suffer from chronic pain, and are dependent on opioid painkillers such as Vicodin, or addicted to street opiates including heroin. Opioid overdose, which claimed celebrities including Prince and Heath Ledger as victims, contributed to more than 33,000 deaths in 2015, according to the Centers for Disease Control and Prevention. Earlier this month, the FDA asked Endo International Plc to withdraw its Opana ER painkiller from the market, the first time the agency has called for the removal of an opioid painkiller for public health reasons. The FDA concluded that the drug's benefits no longer outweighed its risks. Multiple studies have shown that pro-medical marijuana states have reported fewer opiate deaths and there are no deaths related to marijuana overdose on record.(http://reut.rs/2r74Sbe) © 2017 Scientific American

Keyword: Pain & Touch; Drug Abuse
Link ID: 23774 - Posted: 06.26.2017

By STEPH YIN European eels are born and die in the North Atlantic Ocean, but spend most of their lives in rivers or estuaries across Europe and North Africa. In between, they traverse thousands of miles of ocean, where it’s often unclear which way is up or down. Scientists have therefore long suspected that these critically endangered fish use magnetism to help guide them. A study published Friday in Science Advances shows, for the first time, that European eels might link magnetic cues with the tides to navigate. Studying juveniles during the crucial stage when they move toward land from open ocean, the authors found that eels faced different directions based on whether the tide was flowing in (flood tide) or out (ebb tide). Changing orientation might help eels take advantage of tides to travel from the ocean to the coast, and into fresh water, more efficiently, said Alessandro Cresci, a graduate student at the University of Miami and lead author of the study. Previous studies have shown that eels can detect magnetic fields, but how they use this sixth sense “has remained a matter of speculation” until now, said Michael J. Miller, an eel biologist at Nihon University in Japan who was not involved in the study. When transitioning from sea to coast, European eels are in a stage of their lives where they are about the size of a finger and transparent along their bodies, thus the name “glass eels.” Mr. Cresci’s group studied glass eels from the coast of Norway, observing the animals in the field by putting 54 slippery, see-through eels, one by one, in a drifting chamber equipped with cameras and compasses. When the tide ebbed, these animals generally faced south, but when it flowed in, they showed no consistent orientation. The researchers then studied 49 of the same eels in laboratory tanks. They subjected some of the eels to reoriented magnetic fields, rotating magnetic north to the east, south or west. © 2017 The New York Times Company

Keyword: Animal Migration
Link ID: 23728 - Posted: 06.12.2017

Rob Stein The Food and Drug Administration requested Thursday that the drugmaker Endo Pharmaceuticals stop selling Opana ER — its extended-release version of Opana. The FDA says the move marks the first time the agency has taken steps to remove an opioid from the market because of "public health consequences of abuse." An increasing number of people, the FDA says, are abusing the powerful prescription pills by crushing, dissolving and injecting them. The sharing of needles by these drug users has fueled an outbreak of associated infectious diseases — HIV, hepatitis C and another serious blood disorder. "We are facing an opioid epidemic — a public health crisis, and we must take all necessary steps to reduce the scope of opioid misuse and abuse," says Dr. Scott Gottlieb, the FDA's commissioner, in announcing the move. "We will continue to take regulatory steps when we see situations where an opioid product's risks outweigh its benefits, not only for its intended patient population but also in regard to its potential for misuse and abuse," Gottlieb says. Dangers Of Opana Opioid Painkiller Outweigh Benefits, FDA Panel Says In a written statement, Endo says the company is "reviewing the request and is evaluating the full range of potential options as we determine the appropriate path forward." The company defended its drug, a version of the medicine oxymorphone hydrochloride, citing the opioid's effectiveness in alleviating pain and Endo's efforts to prevent abuse. © 2017 npr

Keyword: Drug Abuse; Pain & Touch
Link ID: 23725 - Posted: 06.09.2017

By NICHOLAS BAKALAR Chronic pain may be linked to an increasing risk for dementia. Researchers interviewed 10,065 people over 62 in 1998 and 2000, asking whether they suffered “persistent pain,” defined as being often troubled with moderate or severe pain. Then they tracked their health through 2012. After adjusting for many variables, they found that compared with those who reported no pain problems, people who reported persistent pain in both 1998 and 2000 had a 9 percent more rapid decline in memory performance. Moreover, the probability of dementia increased 7.7 percent faster in those with persistent pain compared with those without. The study, in JAMA Internal Medicine, does not prove cause and effect. But chronic pain may divert attention from other mental activity, leading to poor memory, and some studies have found that allaying pain with opioids can lead to cognitive improvements. Still, the lead author, Dr. Elizabeth L. Whitlock, an anesthesiologist at the University of California at San Francisco, acknowledged that treatment with opioids is problematic, and that safely controlling chronic pain is a problem that so far has no satisfactory solution. “I’d encourage clinicians to be aware of the cognitive implications of a simple report of pain,” she said. “It’s a simple question to ask, and the answer can be used to identify a population at high risk of functional and cognitive problems.” © 2017 The New York Times Company

Keyword: Alzheimers; Pain & Touch
Link ID: 23719 - Posted: 06.08.2017

By Matthew Hutson The life of a sheep is not as cushy as it looks. They suffer injury and infection, and can’t tell their human handlers when they’re in pain. Recently, veterinarians have developed a protocol for estimating the pain a sheep is in from its facial expressions, but humans apply it inconsistently, and manual ratings are time-consuming. Computer scientists at the University of Cambridge in the United Kingdom have stepped in to automate the task. They started by listing several “facial action units” (AUs) associated with different levels of pain, drawing on the Sheep Pain Facial Expression Scale. They manually labeled these AUs—nostril deformation, rotation of each ear, and narrowing of each eye—in 480 photos of sheep. Then they trained a machine-learning algorithm by feeding it 90% of the photos and their labels, and tested the algorithm on the remaining 10%. The program’s average accuracy at identifying the AUs was 67%, about as accurate as the average human, the researchers will report today at the IEEE International Conference on Automatic Face and Gesture Recognition in Washington, D.C. Ears were the most telling cue. Refining the training procedure further boosted accuracy. Given additional labeled images, the scientists expect their method would also work with other animals. Better diagnosis of pain could lead to quicker treatment. © 2017 American Association for the Advancement of Science. A

Keyword: Pain & Touch
Link ID: 23694 - Posted: 06.02.2017

Laurel Hamers Last year, Joan Peay slipped on her garage steps and smashed her knee on the welcome mat. Peay, 77, is no stranger to pain. The Tennessee retiree has had 17 surgeries in the last 35 years — knee replacements, hip replacements, back surgery. She even survived a 2012 fungal meningitis outbreak that sickened her and hundreds of others, and killed 64. This knee injury, though, “hurt like the dickens.” When she asked her longtime doctor for something stronger than ibuprofen to manage the pain, he treated her like a criminal, Peay says. His response was frustrating: “He’s known me for nine years, and I’ve never asked him for pain medicine other than what’s needed after surgery,” she says. She received nothing stronger than over-the-counter remedies. A year after the fall, she still lives in constant pain. Just five years ago, Peay might have been handed a bottle of opioid painkillers for her knee. After all, opioids — including codeine, morphine and oxycodone — are some of the most powerful tools available to stop pain. Hitting opioid receptors in the peripheral nervous system keeps pain messages from reaching the brain. But opioids can cause problems by overstimulating the brain’s reward system and binding to receptors in the brain stem and gut. But an opioid addiction epidemic spreading across the United States has soured some doctors on the drugs. Many are justifiably concerned that patients will get hooked or share their pain pills with friends and family. And even short-term users risk dangerous side effects: The drugs slow breathing and can cause constipation, nausea and vomiting. |© Society for Science & the Public 2000 - 2017

Keyword: Pain & Touch; Drug Abuse
Link ID: 23686 - Posted: 05.31.2017

Patients who are told their medication can have certain side-effects may report these symptoms more often than patients who aren't aware their treatment carries these risks, a study of popular cholesterol pills suggests. Researchers focused on what they dubbed the "nocebo" effect, or the potential for people to complain of treatment-related side-effects when they think they're taking a specific drug but are actually given a placebo, or dummy pill, without any active ingredients. "It has been recognized for many years that when patients are warned about possible adverse reactions to a drug, they are much more likely to complain of these side effects than when they are unaware of the possibility that such side-effects might occur," said senior study author Dr. Peter Sever, a researcher at Imperial College London. To test this "nocebo" effect, researchers first randomly assigned about 10,000 trial participants in the UK, Ireland and Scandinavia to take either a statin pill to lower cholesterol or a placebo, then followed people for around three years to see how often they complained of four known statin side-effects: Patients on statins and on placebo pills reported similar rates of muscle aches and erectile dysfunction, the study found. People taking placebo also reported higher rates of sleep difficulties than patients on statins. ©2017 CBC/Radio-Canada.

Keyword: Pain & Touch
Link ID: 23665 - Posted: 05.27.2017

Laura Beil Even though a sprained ankle rarely needs an opioid, a new study of emergency room patients found that about 7 percent of patients got sent home with a prescription for the potentially addictive painkiller anyway. And the more pills prescribed, the greater the chance the prescription would be refilled, raising concerns about continued use. The research adds to evidence that it’s hard for some people to stop taking the pills even after a brief use. State officials in New Jersey recently enacted a law limiting first-time prescriptions to a five-day supply, and other states should consider similar restrictions, says Kit Delgado, an assistant professor of Emergency Medicine and Epidemiology at the University of Pennsylvania. “The bottom line is that we need to do our best not to expose people to opioids,” Delgado says. “And if we do, start with the smallest quantity possible.” The research was presented May 17 at the Society for Academic Emergency Medicine’s annual meeting in Orlando. Previous research has found that the more opioids such as hydrocodone and oxycodone are prescribed, the more likely patients are to keep taking them. But previous studies have been too broad to account for differences in diagnoses — for instance, whether people who received refills kept taking the drug simply because they still were in pain, Delgado says. He and colleagues limited their study to prescriptions written after ankle sprains to people who had not used an opioid in the previous six months. Usually, those injuries aren’t serious and don’t require opioids. |© Society for Science & the Public 2000 - 2017

Keyword: Drug Abuse; Pain & Touch
Link ID: 23638 - Posted: 05.20.2017

By Roman Liepelt and Jack Brooks An amputee struggles to use his new prosthetic limb. A patient with a frontal-lobe brain lesion insists that her left hand has a mind of its own. The alleged criminal claims in court that he did not fire the gun, even though several eyewitnesses watched him do it. Each of these individuals is grappling with two elements of the mind-body connection: ownership, or an ability to separate ourselves from the physical and social environments, and agency, a conviction that we have control over our limbs. We are quick to investigate a sticker placed on our forehead when looking in a mirror, recognizing the foreign object as abnormal. The human brain typically handles these phenomena by comparing neural signals encoding the intended action with those signals carrying sensory feedback. When we are born, we make erratic reaching and kicking movements to map our body and to calibrate our sensorimotor system. During infancy, these movements solidify our self-awareness, and around the time we first walk, we are quick to investigate a sticker placed on our forehead when looking in a mirror, recognizing the foreign object as abnormal. By the age of four, our brains are proficient at distinguishing self and other. In the amputee, the brain lesion patient, and the defendant on trial, the sense of self is disrupted due to discordance between sensory feedback from the limb and the brain’s expectations of how a movement should feel. © 1986-2017 The Scientist

Keyword: Pain & Touch
Link ID: 23625 - Posted: 05.17.2017

By Moheb Costandi Pain in infants is heartbreaking for new parents, and extremely difficult to treat effectively—if at all. Every year an estimated 15 million babies are born prematurely, most of whom will then undergo numerous lifesaving but painful procedures, such as heel pricking or insertion of a thin tube known as a cannula to deliver fluids or medicine. Preterm babies in the intensive care unit are subjected to an average of 11 such “skin-breaking” procedures per day, but analgesia is only used just over one third of the time. We know that repetitive, painful procedures in early infancy can impact brain development negatively—so why is pain in infants so undertreated? One reason is the lack of standard guidelines for administering the drugs. Some analgesics given to adults are unsuitable for infants, and those that can be used often have different effects in children, making dosing a problem. What is more, newborn babies are incapable of telling us how they feel, making it impossible to determine how effective any painkiller might be. Researchers at the University of Oxford may now have overcome this latter challenge, however. They report May 3 in Science Translational Medicine having identified a pain-related brain wave signal that responds to analgesics, and could be used to measure the drugs’ efficacy. Until as recently as the 1980s, it was assumed that newborn babies do not feel pain, and that giving them analgesics would do more harm than good. Although these misconceptions have been cleared up, we still have very little understanding of infant pain, and so treating it is a huge challenge for clinicians. © 2017 Scientific American

Keyword: Pain & Touch
Link ID: 23576 - Posted: 05.05.2017