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

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Sarah Boseley Health editor A new drug to relieve pain during labour works better than pethidine, which has been in widespread use since the 1950s even though it has long been known it does not help all women, say researchers. Pethidine is given as an injection, but a new study funded by the National Institute for Health Research shows that remifentanil, which women control by pressing a button when they feel pain, appears to be more effective. Women using remifentanil were half as likely to end up asking for an epidural, which blocks all pain and sensation and often leads to a forceps delivery. Pethidine was the first opioid drug that was allowed to be given by a midwife alone and was very widely adopted, said Dr Matthew Wilson, a senior lecturer at the University of Sheffield and the lead author of the study published in the Lancet medical journal. More than a quarter of a million women in labour are given pethidine each year in the UK, even though up to 40% do not find it helpful, he said. “Some women do not report any useful pain relief at all and it has significant side effects,” he said. That includes sedation and potentially affecting the baby. “There has been a longstanding need for something else,” he said. Epidurals are by far the most effective form of pain relief, but women who have them are more likely to end up with their baby having a forceps or vacuum delivery. That can sometimes cause damage to the mother and have long-term consequences, including sexual problems. © 2018 Guardian News and Media Limited

Keyword: Pain & Touch
Link ID: 25331 - Posted: 08.15.2018

Tina Hesman Saey Some snippets of RNA can be a real pain. A microRNA called miR-30c-5p contributes to nerve pain in rats and people, a new study finds. A different microRNA, miR-711, interacts with a well-known itch-inducing protein to cause itching, a second study concludes. Together, the research highlights the important role that the small pieces of genetic material can play in nerve cell function, and may help researchers understand the causes of chronic nerve pain and itch. MicroRNAs help regulate gene activity and protein production. The small molecules play a big role in controlling cancer (SN: 8/28/10, p. 18) and other aspects of health and disease (SN: 2/20/16, p. 18). Usually, microRNAs work by pairing up with bigger pieces of RNA called messenger RNAs, or mRNA. Messenger RNAs contain copies of genetic instructions that are read by cellular machinery to build proteins. When microRNAs glom onto the messengers, the mRNA can be degraded or the microRNAs can prevent the protein-building machinery from reading the instructions. Either way, the result is typically to dial down production of certain proteins. In the case of nerve pain, miR-30c-5p limits production of an important protein called TGF-beta that’s involved in controlling pain, María Hurlé, a pharmacologist at the University of Cantabria in Santander, Spain, and colleagues report August 8 in Science Translational Medicine. The researchers discovered the link in experiments with mice, rats and people. |© Society for Science & the Public 2000 - 2018.

Keyword: Pain & Touch
Link ID: 25329 - Posted: 08.14.2018

Michaeleen Doucleff My back hurts when I sit down. It's been going on for 10 years. It really doesn't matter where I am — at work, at a restaurant, even on our couch at home. My lower back screams, "Stop sitting!" To try to reduce the pain, I bought a kneeling chair at work. Then I got a standing desk. Then I went back to a regular chair because standing became painful. I've seen physical therapists, orthopedic surgeons and pain specialists. I've mastered Pilates, increased flexibility and strengthened muscles. At one point, my abs were so strong my husband nicknamed them "the plate." All these treatments helped a bit, at first. But the pain never really went away. So a few years ago, I decided to accept reality: Sitting down is — and will always be — painful for me. Then back in November, I walked into the studio of Jenn Sherer in Palo Alto, Calif. She is part of a growing movement on the West Coast to teach people to move and sit and stand as they did in the past — and as they still do in other parts of the world. I was interviewing Sherer for a story about bending. But she could tell I was in pain. So I told her my story. Her response left me speechless: "Sitting is a place where you can find heaven in your joints and in your back," she says. "It's not sitting that's causing the pain, it's how you're sitting. "Do you want me to show you how?" © 2018 npr

Keyword: Pain & Touch
Link ID: 25322 - Posted: 08.13.2018

Frances Perraudin Deaths caused by the drug fentanyl rose by nearly 30% last year, according to figures from the Office for National Statistics. While statistics show that the rate of deaths from drug poisoning in England and Wales has remained steady – 66.1 deaths per 1 million people (3,756 deaths) – fatalities involving the synthetic opioid fentanyl were up 29%. There were 75 deaths in 2017, up from 58 deaths in 2016. Fentanyl has been found mixed with street heroin, causing accidental overdose in users. The drug can up to 100 times stronger than heroin and is sometimes prescribed as a painkiller for the terminally ill. One type of fentanyl, carfentanyl, is 10,000 times stronger and is used as an elephant tranquilliser. It was first seen mentioned in death certificates in 2017 and accounted for 27 deaths, 87% of the 31 deaths related to types of fentanyl in 2017. In April 2017, after a spate of deaths linked to fentanyl in northern England, Public Health England issued a warning to heroin users to be extra careful when using the drug, urging them to test a small amount first and not to take it alone. The ONS statistics also show that deaths from cocaine were up for the sixth year in a row. There were 432 deaths related to the drug in 2017, compared with 371 deaths in 2016. In June a report by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) found that purity of street cocaine across Europe was at its highest level in a decade and the number of people seeking treatment for use of the drug was on the rise. © 2018 Guardian News and Media Limited

Keyword: Drug Abuse; Pain & Touch
Link ID: 25295 - Posted: 08.06.2018

By Elizabeth Gamillo Conservationists trying to restore the United States’s grasslands kept running into a problem: As soon as they planted the seeds meant to bring back native flora, hungry mice would gobble them up. In an effort to deter the rodents, biologists tried coating the seeds with capsaicin, the active ingredient that gives chili peppers their signature fiery taste. It worked: Dusting the seeds with chili powder reduced the number of seeds consumed by deer mice by 86%, researchers report in Restoration Ecology. The hot discovery required some trial and error. One big challenge was finding a chili powder that would deter the mice but not prevent the seeds from germinating. Another was finding a coating that wouldn’t weather away after a few months outdoors. After 4 years of laboratory and field experiments in Montana’s Missoula Valley, researchers found a workable recipe. A powder made from the Bhut jolokia, or ghost pepper, from India—considered to be one of the world’s hottest chilis—did the trick. The scientists suggest their findings demonstrate how nontoxic, natural plant defense compounds—such as capsaicin—can be used to aid restoration efforts. © 2018 American Association for the Advancement of Science

Keyword: Pain & Touch
Link ID: 25294 - Posted: 08.06.2018

By Emily Baumgaertner WASHINGTON — A fast-acting class of fentanyl drugs approved only for cancer patients with high opioid tolerance has been prescribed frequently to patients with back pain and migraines, putting them at high risk of accidental overdose and death, according to documents collected by the Food and Drug Administration. The F.D.A. established a distribution oversight program in 2011 to curb inappropriate use of the dangerous medications, but entrusted enforcement to a group of pharmaceutical companies that make and sell the drugs. Some of the companies have been sued for illegally promoting other uses for the medications and in one case even bribing doctors to prescribe higher doses. About 5,000 pages of documents, obtained by researchers at the Johns Hopkins Bloomberg School of Public Health through the Freedom of Information Act and provided to The New York Times, show that the F.D.A. had data showing that so-called off-label prescribing was widespread. But officials did little to intervene. “If any opioids were going to be tightly regulated, it would be these,” said Dr. Andrew Kolodny, an opioid policy researcher at Brandeis University, who was not involved in the investigation. “They had the fox guarding the henhouse, people were getting hurt — and the F.D.A. sat by and watched this happen.” Officials at the F.D.A. said they had reviewed evidence indicating that many patients without cancer were given the drugs. But they said that piecemeal data from various stakeholders — prescriber surveys, insurance claims and industry reports — made it difficult for the agency to measure potential harm to patients. “The information we have isn’t very good, but it seems to indicate people who aren’t cancer patients are getting this and people who aren’t opioid tolerant are getting this,” Dr. Janet Woodcock, the director of the Center for Drug Evaluation and Research at the F.D.A., said in an interview. © 2018 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 25291 - Posted: 08.04.2018

Ashley Yeager European health officials have approved the sale of the migraine-prevention drug Aimovig (erenumab), The Guardian reports today (July 31). In May, the US Food and Drug Administration gave the green light for the same drug, considered a first of its kind because it blocks a receptor that plays a role in transmitting signals of migraine pain. “Migraine is incredibly painful, and has symptoms that include vomiting and visual disturbance, so getting it frequently can literally ruin lives,” Wendy Thomas, chief executive of the Migraine Trust, tells The Guardian. “That is why it is important that [the drug] becomes available to patients as soon as possible.” Aimovig targets the calcitonin gene-related peptide (CGRP) receptor, and in clinical trials the compound was shown to reduce the number of days individuals suffered migraines each month. One in four patients with chronic migraines—those experiencing symptoms 15 days or more a month—were migraine-free for more than 15 months. “A treatment specifically designed for migraine prevention is a much welcomed innovation and could transform lives of patients for whom current therapies do not work or are not well tolerated,” Patrick Little, president of the European Migraine and Headache Alliance, said in a June 30 statement from Novartis, the company that manufactures Aimovig. In the trials, the drug was tested on migraine sufferers who did not get relief from two to four other commonly used migraine treatments. © 1986 - 2018 The Scientis

Keyword: Pain & Touch
Link ID: 25282 - Posted: 08.02.2018

by Lenny Bernstein A quarter of the adults who went to hospital emergency departments with sprained ankles were prescribed opioid painkillers, a new study shows, in another sign of how commonly physicians turn to narcotics even for minor injuries. The state-by-state review revealed wide variation in the use of opioids for the sprains, from 40 percent in Arkansas to 2.8 percent in North Dakota. All but one of the nine states that recorded above-average opioid prescribing are in the South or Southwest. None are in the parts of Appalachia or New England that have been hit hardest by the opioid epidemic. The analysis of 30,832 private insurance claims from 2011 to 2015 revealed that emergency department prescriptions can influence long-term opioid use. The median prescription was 15 tablets, or three days’ worth of hydrocodone, oxycodone, tramadol or other narcotics. Patients who received the largest amounts were five times as likely to continue with prolonged opioid use than those given 10 tablets or fewer, though their overall numbers were relatively small. The recipients were not known to have previously used opioids. Opioid prescriptions written by emergency room doctors are responsible for a small portion of the vast amount of narcotic painkillers consumed by patients each year. Most prescriptions come from primary-care physicians. There were about 215 million prescriptions for the drugs in 2016, according to the Centers for Disease Control and Prevention. © 1996-2018 The Washington Post

Keyword: Drug Abuse; Pain & Touch
Link ID: 25264 - Posted: 07.28.2018

By Aaron E. Carroll Promising health studies often don’t pan out in reality. The reasons are many. Research participants are usually different from general patients; their treatment doesn’t match real-world practice; researchers can devote resources not available in most physician offices. Moreover, most studies, even the gold standard of randomized controlled trials, focus squarely on causality. They are set up to see if a treatment will work in optimal conditions, what scientists call efficacy. They’re “explanatory.” Efficacy is important. But what we also need are studies that test if a treatment will work in the real world — if they have effectiveness. These different kinds of studies actually exist. They are called pragmatic trials, and a recent one might have helped serve as a brake as the opioid epidemic accelerated. Pragmatic trial design was described more than 50 years ago in the Journal of Chronic Diseases (in a paper reprinted nine years ago in the Journal of Clinical Epidemiology). A pragmatic trial seeks to determine if, and how, an intervention might work in practice, where decisions are more complicated than in a strictly controlled clinical trial. Studies are almost never purely pragmatic or explanatory: They fall on a continuum. A recent tool, known as Precis-2, can help researchers devise trials to lean one way or the other. It’s scored on nine domains — eligibility criteria, recruitment, setting, organization, flexibility (delivery), flexibility (adherence), follow-up, primary outcome and primary analysis — on a scale from 1 (explanatory, or “ideal conditions”) to 5 (pragmatic, or “real world”). Why do we need all this? Let’s take chronic pain as an example. Those who suffer from it want relief, and they want it now. Because people know that opioids exist, it’s hard to get them into a trial where they might take less powerful pain medications, like acetaminophen or ibuprofen. It’s also hard to do the long-term studies we need, because patients often want to try other options if the first one doesn’t work. © 2018 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 25238 - Posted: 07.23.2018

Patti Neighmond If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a scale of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach. The numeric pain scale may just be too simplistic, says Dr. John Markman, Director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to "treat by numbers," he says and as a result, patients may not be getting the most effective treatment for their pain. Take the case of 33-year-old Adam Rosette, who was recently hospitalized for fibrous dysplasia, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high. "I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb," he recalls. On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe. Today, Rosette has recovered and is pain-free, but he wonders if "low balling" his pain level while in the hospital, meant he wasn't given adequate pain medication. "You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while," Rosette says. © 2018 npr

Keyword: Pain & Touch
Link ID: 25237 - Posted: 07.23.2018

Wade Goodwyn In hospitals around the country, anesthesiologists and other doctors are facing significant shortages of injectable opioids. These drugs, like morphine, Dilaudid and fentanyl are the mainstays of intravenous pain control and are regularly used in critical care settings like surgery, intensive care units and hospital emergency departments. The distance medical science has traveled over the last hundred years in pain management is practically miraculous. Walk into a pediatric intensive care unit at any major hospital in the country and, even though the children you'll see are critically ill from disease and surgery, you won't see any of them squirming in the bed in pain or discomfort. Though a child in this ICU may be diagnosed with an incurable disease, pediatric doctors are able to use hydromorphone, fentanyl and liquid morphine to keep the patient's suffering at a distance all the way to the end. The same is true for pain management in adults. It's not just the patient who's spared — relatives, friends, not to mention doctors, nurses and the other health care providers don't have to experience a cherished human being writhing in agony. That is why doctors across the country have grown increasingly concerned that hospitals and other medical facilities have been running low on or out of the supplies they need. Dr. Red Starks, a pediatric anesthesiologist who has been practicing for 26 years, said that for him the shortage "escalated late this spring when we didn't have any morphine." "Or one week we had morphine but we didn't have Dilaudid," he continued, "and two weeks later we'd get a little trickle of Dilaudid but we wouldn't have any morphine. And you're just thinking, 'Hello, am I in the 21st century?' " © 2018 npr

Keyword: Pain & Touch; Drug Abuse
Link ID: 25229 - Posted: 07.20.2018

Aimee Cunningham Painkillers crafted with a part of the wrinkle-smoothing drug Botox provide long-term pain relief in mice. Researchers added the modified Botox to molecules that target pain-messaging nerve cells. Mice given a single spinal injection of the new drugs showed signs of pain relief for the full duration of the experiments, around three weeks, researchers report online July 18 in Science Translational Medicine. Such painkillers could potentially one day be developed for humans as alternatives to more addictive drugs, such as opioids. Created by the bacterium Clostridium botulinum, botulinum toxin causes the food poisoning disease botulism. Botox, which is made from the toxin, is often injected into people to iron out worry lines and has been used to treat conditions that involve overactive muscles, such as repetitive neck spasms or overactive bladder (SN: 4/5/08, p. 213). The toxin has also been used to reduce the frequency of migraines. Biochemist Bazbek Davletov of the University of Sheffield in England and colleagues focused on botulinum toxin because it can stop certain nerve cells from communicating with one another for up to five months with each injection. And “you locally inject less than a millionth of a gram, which is helpful to avoid any immune response,” he says. Davletov and colleagues created their new drugs with a process he describes as a “molecular Lego system.” Taking the part of the botulinum toxin that blocks nerve cells from sending messages, the team attached the piece to one of two molecules that target neurons that relay pain information. The researchers removed the part of the toxin, found in Botox, that binds to muscle-controlling nerve cells. |© Society for Science & the Public 2000 - 2018.

Keyword: Pain & Touch
Link ID: 25228 - Posted: 07.19.2018

By Nicholas Bakalar In a randomized clinical trial, researchers assigned 120 men and women with chronic back or neck pain to one of two treatments. The first group received the commonly recommended program of physical therapy and general exercises. The second received a program of “pain neuroscience education,” in which they learned about the function of neurons and synapses, the ways in which pain is transmitted along nerve fibers via the spinal cord to the brain, and how pain itself can modify central nervous system functions, producing pain with even the mildest stimulation. They also performed exercises, closely integrated with the education program, that gradually introduced increasingly difficult movements, concentrating on functionality rather than pain relief, and trying to continue exercising despite the pain. Treatment in both groups lasted three months, and researchers re-examined the participants at six and 12 months afterward. Compared to the controls, the neuroscience education group had higher pain thresholds, a significant reduction in disability, and improved self-reported physical and mental health. The study is in JAMA Neurology. “The main message is: Don’t be afraid of the pain,” said the lead author, Anneleen Malfliet, a doctoral candidate at the Free University of Brussels. “We know that worrying and giving attention to pain ultimately increases it. Staying active and moving is better than rest when it comes to chronic back and neck pain.” © 2018 The New York Times Company

Keyword: Pain & Touch
Link ID: 25199 - Posted: 07.13.2018

Will Stone It started with a rolled ankle during a routine training exercise. Shannon Hubbard never imagined it was the prologue to one of the most debilitating pain conditions known to exist, called ­­­­­­­complex regional pain syndrome. It's a condition that causes the nervous system to go haywire, creating pain disproportionate to the actual injury. It can also affect how the body regulates temperature and blood flow. For Hubbard, it manifested several years ago following surgery on her foot. That's a common way for it to take hold. "My leg feels like it's on fire pretty much all the time. It spreads to different parts of your body," the 47-year-old Army veteran says. Hubbard props up her leg, careful not to graze it against the kitchen table in her home east of Phoenix. It's red and swollen, still scarred from an ulcer that landed her in the hospital a few months ago. "That started as a little blister and four days later it was like the size of a baseball," she says. "They had to cut it open and then it got infected and because I have blood flow issues, it doesn't heal." She knows that soon it will happen again. "Over the past three years, I've been prescribed over sixty different medications and combinations, none have even touched the pain," she says. She holds up a plastic bag filled with discarded pill bottles — evidence of her elusive search for a solution to the pain. © 2018 npr

Keyword: Pain & Touch; Drug Abuse
Link ID: 25183 - Posted: 07.09.2018

The musician Tom Petty last year joined a long line of high-profile stars to hit the headlines for dying from an accidental overdose of prescription painkillers and tranquillizers. The risks of opioid painkillers dominate the news. But the other half of the deadly mixture in such overdose cases deserves attention, too. It’s typically a medicine from a class of drugs called benzodiazepines or — more colloquially — benzos. These drugs — Valium (diazepam), Xanax (alprazolam) and the like — have been prescribed as tranquillizers for decades, mainly for anxiety. And the health risks they pose, such as addiction, are well known. Yet a study published last week spells out the specific danger of mixing them with an opioid painkiller: the risk of an overdose is five times higher when people taking opioids are also prescribed a benzodiazepine (I. Hernandez et al. JAMA Network Open 1, e180919; 2018). According to the US National Institutes of Health’s National Institute of Drug Abuse, almost one-third of overdoses involving opioids also involve benzos. The problems come because both opioids and benzos function as depressants on the central nervous system. Acting together, they can make it difficult to breathe — so difficult, in fact, that many overdose deaths are caused by suffocation. As a result, the US Food and Drug Administration (FDA), among other regulatory bodies, has repeatedly tried to highlight the risks of prescriptions for both types of drug. In a perspective article published last month, the FDA called for “proactive pharmacovigilance” — better tracking of the drugs that different (and sometimes the same) doctors prescribe to patients (D. C. Throckmorton et al. N. Engl. J. Med.; 2018). © 2018 Macmillan Publishers Limited, p

Keyword: Drug Abuse; Pain & Touch
Link ID: 25152 - Posted: 06.28.2018

By Nicola Twilley On a foggy February morning in Oxford, England, I arrived at the John Radcliffe Hospital, a shiplike nineteen-seventies complex moored on a hill east of the city center, for the express purpose of being hurt. I had an appointment with a scientist named Irene Tracey, a brisk woman in her early fifties who directs Oxford University’s Nuffield Department of Clinical Neurosciences and has become known as the Queen of Pain. “We might have a problem with you being a ginger,” she warned when we met. Redheads typically perceive pain differently from those with other hair colors; many also flinch at the use of the G-word. “I’m sorry, a lovely auburn,” she quickly said, while a doctoral student used a ruler and a purple Sharpie to draw the outline of a one-inch square on my right shin. Wearing thick rubber gloves, the student squeezed a dollop of pale-orange cream into the center of the square and delicately spread it to the edges, as if frosting a cake. The cream contained capsaicin, the chemical responsible for the burn of chili peppers. “We love capsaicin,” Tracey said. “It does two really nice things: it ramps up gradually to become quite intense, and it activates receptors in your skin that we know a lot about.” Thus anointed, I signed my disclaimer forms and was strapped into the scanning bed of a magnetic-resonance-imaging (MRI) machine. The machine was a 7-Tesla MRI, of which there are fewer than a hundred in the world. The magnetic field it generates (teslas are a unit of magnetic strength) is more than four times as powerful as that of the average hospital MRI machine, resulting in images of much greater detail. As the cryogenic units responsible for cooling the machine’s superconducting magnet clicked on and off in a syncopated rhythm, the imaging technician warned me that, once he slid me inside, I might feel dizzy, see flashing lights, or experience a metallic taste in my mouth. “I always feel like I’m turning a corner,” Tracey said. She explained that the magnetic field would instantly pull the proton in each of the octillions of hydrogen atoms in my body into alignment. Then she vanished into a control room, where a bank of screens would allow her to watch my brain as it experienced pain. © 2018 Condé Nast.

Keyword: Pain & Touch; Brain imaging
Link ID: 25145 - Posted: 06.26.2018

By JoAnna Klein Every spring in Australia, billions of bogong moths migrate from the arid plains of Queensland, New South Wales and Victoria to the meadows of the Australian Alps to escape the impending heat. There, they congregate in caves like living shingles, and go dormant over the summer. Autumn arrives, and they return to their birthplaces to mate, lay eggs and die. The eggs hatch into caterpillars that develop underground through winter. The cycle continues. How these animals complete this epic journey to a place they’ve never been and back, traveling hundreds of miles at night, for days to weeks each way, has long been a mystery. But scientists have now discovered that bogong moths have a magnetic sense to help them. In a paper published Thursday in Current Biology, they tested how the moths reacted to moving visual cues and magnetic fields in an outdoor flight simulator and found that the winged insects use magnetic fields like a compass. While other animals like nocturnal songbirds and sea turtles are known to migrate by Earth’s magnetic fields, the researchers say this is the first reliable evidence that insects can, too. Australia’s small, brown, ordinary-looking bogong moths are the only known insect besides the monarch butterfly to manage such a long, directed and specific migration. “They have this sort of amazing ability that belies their appearance,” said Eric Warrant, a biologist at the University of Lund in Sweden and the principal investigator of the study. “It’s as if the bogong moth is the dreary-colored, nocturnal cousin of the monarch butterfly.” But unlike the monarch, which flies during the day by a reliably rising and setting sun, the moth flies at night beneath dim constellations and a darting, shape-shifting moon. © 2018 The New York Times Company

Keyword: Animal Migration
Link ID: 25121 - Posted: 06.22.2018

Christine Herman A painkiller prescription could become a ticket for medical marijuana in Illinois. Lawmakers there passed a bill making anyone with a prescription for opioids eligible for its medical cannabis program. With this move, Illinois joins a growing number of states turning to legal cannabis in the fight against painkiller addiction. "As we see the horrible damage inflicted by opioid use and misuse, it seems like a very low-cost and low-risk alternative," says state Sen. Don Harmon, a Democrat from Oak Park, Ill., and sponsor of the Senate version of the bill. The Alternatives to Opioids Act would allow millions of patients to apply for temporary access to the state's existing medical cannabis pilot program. The bill, which passed on May 31, is now awaiting Republican Gov. Bruce Rauner's signature. Though the bill has bipartisan support, marijuana advocates have some doubts about whether he'll sign it, given his past opposition to medical cannabis. Lawmakers in several states have taken action to initiate or expand their medical marijuana programs in light of the opioid crisis. Among them, in Georgia Gov. Nathan Deal signed a law adding PTSD and intractable pain to the list of conditions covered in its medical marijuana program in May. And New York state Sen. George Amedore, a Republican, introduced legislation that would allow doctors to prescribe cannabis oil as an alternative to opioids for certain conditions. Under Illinois' proposed new law, anyone 21 or older with a condition for which opioids might be prescribed could get near-immediate access to cannabis products at licensed dispensaries by presenting paperwork signed by their doctor. They would no longer be fingerprinted or need criminal background checks, or wait months for approval. The measure would reduce the backlog of applications, Harmon says. © 2018 npr

Keyword: Pain & Touch; Drug Abuse
Link ID: 25094 - Posted: 06.16.2018

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

Keyword: Pain & Touch
Link ID: 25064 - Posted: 06.07.2018

By Ingfei Chen Each year, according to the U.S. Department of Agriculture, roughly 820,800 guinea pigs, dogs, cats, and other animals covered by the Animal Welfare Act are used in research in the U.S.; of those, about 71,370 are subjected to unalleviated pain. These stats don’t track the millions of mice and rats that are used in lab experiments and excluded from the animal protection law (although the rodents are covered by other federal regulations). Scientists and their institutions say they’re committed to keeping pain or distress to a minimum in lab animals where they can. But how do you know how much pain a mouse or a zebrafish feels? And who decides how much pain is too much? “We know if they’re in really bad pain, as much as they want a nice nest, they’re not gonna put the work into doing that.” The issue of animal suffering was in the headlines earlier this year, when landlocked Switzerland banned the culinary practice of boiling lobsters alive. No one knows for sure whether these big-clawed crustaceans, equipped with only a rudimentary nervous system, experience pain. Nonetheless, Swiss authorities now require stunning lobsters in a humane way before tossing them into the pot. I read of this milestone in crustacean rights with bemused fascination and anthropomorphic cringing, as I imagined the lobster’s hypothetical plight. But the Swiss move also made me wonder how scientists measure and deal with animal pain in research studies. Experiments that use critters to simulate human illness or injury are stepping stones to the medical treatments we all use. Yet, the benefits we reap must outweigh the costs to animal welfare for those sacrifices to be justified, ethicists and animal advocates say. Copyright 2018 Undark

Keyword: Animal Rights; Pain & Touch
Link ID: 25061 - Posted: 06.06.2018