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

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By Perri Klass, M.D. I believe my mother thought that needing to medicate her own discomfort would be a kind of moral and physical weakness. This applied only to herself; if I told her that I was hurting, or that one of her grandchildren was in pain, she would have been anxious for something to help. She felt our pain, you might say, but she denied her own. I’ve spent the past couple of weeks thinking about pain in children and writing about pain in children — acute pain and chronic pain, pain with shots and pain after surgery, pain medicines and pain specialists. I asked the pain experts I interviewed about the different ways that different people experience pain from the same stimulus: Why does one child cry inconsolably after a needle stick while another, same age, same size needle, watches with curiosity as the shot is administered and doesn’t even flinch? There is a great deal of variation in how much pain people experience, I was told, and by and large we should take people at their word. Some people are more prone to soreness, some are relatively less sensitive, some hypersensitive, and there are differences in the ways that different people process pain, and in the ways they respond to drugs. And “hypersensitive” is not a code word for “complains more” — it’s a neurological category. And then of course there are psychological factors. That is not to say that pain is psychogenic, said Dr. Charles Berde, the founder of the division of pain medicine at Boston Children’s Hospital, and one of my teachers when I did my training there. People who are anxious or terrified of pain, people who have post-traumatic stress disorder, may actually experience more pain, he said, because the pain circuits in their brains are revved up. © 2019 The New York Times Company

Keyword: Pain & Touch
Link ID: 25931 - Posted: 02.04.2019

By Benedict Carey Veteran insomniacs know in their bones what science has to say about sleep deprivation and pain: that the two travel together, one fueling the other. For instance, people who develop chronic pain often lose the ability to sleep well, and quickly point to a bad back, sciatica or arthritis as the reason. The loss of sleep, in turn, can make a bad back feel worse, and the next night’s slumber even more difficult. Why sleep deprivation amplifies pain is not fully worked out, but it has to do with how the body responds to an injury such as a cut or turned ankle. First, it hurts, as nerves send a blast up the spinal cord and into the brain. There, a network of neural regions flares in reaction to the injury and works to manage, or blunt, the sensation. Think of the experience as a kind of physiological dialogue between the ground unit that took the hit and the command-control center trying to contain the damage. In a new study, a team of neuroscientists has clarified the nature of the top-down portion of that exchange, and how it is affected by sleep. In a sleep-lab experiment, the researchers found that a single night of sleep deprivation reduced a person’s pain threshold by more than 15 percent and left a clear signature in the brain’s pain-management centers. In a separate experiment, the team determined that small deviations in the average amount of sleep from one day to another predicted the level of overall pain felt the next day. “What’s exciting about these findings is that they will stimulate, and justify, doing more research to figure this system out,” said Michael J. Twery, director of the sleep disorders branch of the National Heart, Lung and Blood Institute, who was not involved in the new study. “Once we understand how sleep deprivation changes how these pathways function, we should be able to manage pain more effectively — all types of pain.” © 2019 The New York Times Company

Keyword: Sleep; Pain & Touch
Link ID: 25909 - Posted: 01.29.2019

By Perri Klass, M.D. Acute pain that calls out to warn you — “Hey, don’t walk on this broken leg!” — may be unpleasant, but it’s also protective. That acute pain is letting you know that a part of your body needs to heal, or in some other way needs extra attention, said Dr. Neil Schechter, the director of the chronic pain clinic at Boston Children’s Hospital. That’s very different, he said, from chronic pain that goes on over the course of months, whether abdominal pain or headache or musculoskeletal — it may persist and be incapacitating, because “the pain has become the disease.” That doesn’t mean the pain is any less painful for the person experiencing it. “There is really strong evidence supporting the psychological treatment for chronic pain, and that doesn’t imply that the pain itself is a psychological problem,” said Rachael Coakley, a psychologist who is the director of clinical innovation and outreach in pain medicine at Boston Children’s Hospital. Her book, “When Your Child Hurts,” is an excellent resource for parents. “When you’re a kid and you’ve had pain for a really long time, a lot of that is an experience of not having control over what’s happening in your body,” said Anna C. Wilson, a pediatric pain psychologist at Oregon Health and Science University. “Relaxation and other biobehavioral techniques help kids gain a sense of control.” She tells patients, “Your pain is absolutely real, and chronic pain in particular is a neurologic problem.” She recommended TED Talks by Dr. Elliot Krane, an anesthesiologist, and Lorimer Moseley, a neuroscience professor, to help explain chronic pain. Chronic pain develops, Dr. Schechter said, when there is an underlying biological vulnerability, either inherited or resulting from stressors like infections or procedures or traumas, and then a triggering event, such as a gastrointestinal infection or an injury. © 2019 The New York Times Company

Keyword: Pain & Touch; Development of the Brain
Link ID: 25887 - Posted: 01.21.2019

Jonathan Lambert Pain is a complicated experience. Our skin and muscles sense it, just like they sense softness or warmth. But unlike other sensations, the experience of pain is distinctly unpleasant. Pain has to hurt for us to pay attention to it, and avoid hurting ourselves further. But for people in chronic pain, the pain has largely lost its purpose. It just hurts. While it has long been understood how nerves signal pain to the brain, scientists haven't known how the brain adds a layer of unpleasantness. Findings of a study published Thursday in Science offer an answer. A research team from Stanford University pinpointed the neurons in mouse brains that make pain hurt and were able to alter these neurons in a way that reduced the unpleasantness of pain without eliminating the sensation. The study lays the groundwork for future research into more targeted pain treatments. "This study is a major advance," says Irene Tracey, a pain neuroscientist at Oxford University who wasn't involved in the study. "It was a tour de force and a welcome addition to understanding this complex and major problem." Stanford neuroscientist Grégory Scherrer, who co-led the study, started the search for pain neurons in the amygdala — the slim, almond-shaped region scientists know regulates many emotions. The challenge for Scherrer was to sift through the tangle of neurons there and identify the ones associated with pain. © 2019 npr

Keyword: Pain & Touch
Link ID: 25884 - Posted: 01.19.2019

Emily Chung · CBC News · Could the pain you feel in your body be all in your head? At least some of it might be — if you're a man (or a male mouse), a new study has found. Male humans and male mice — but not females of either species — both became hypersensitive to pain when put in an environment where they had previous had a painful experience, reports a new Canadian-led study published last week in the journal Current Biology. "The sex difference was completely unexpected," said Loren Martin, the University of Toronto Mississauga assistant professor of psychology who led the study. While there was no reason to believe males and females would respond differently, if they did, he would have expected females, not males, to develop pain hypersensitivity, since they're generally more sensitive to pain and more prone to chronic pain. Martin originally ran an experiment on mice while he was a postdoctoral researcher in the lab of McGill University professor Jeffrey Mogil, who holds two research chairs related to pain. They wanted to to see how the mice would react if brought back to a place where they had had a painful experience — a 30-minute tummy ache cause by dilute vinegar in their stomachs — and whether they could be conditioned to be hypersensitive to pain. The reason they were interested is because there is growing evidence that chronic pain is linked to biochemical "rewiring" in nerves similar to what happens with the formation of memories in the brain, and may itself be akin to or linked to memory, Martin said. If that's the case, chronic pain could potentially be treated by de-rewiring the nerves back to their normal state. ©2018 CBC/Radio-Canada

Keyword: Pain & Touch; Sexual Behavior
Link ID: 25864 - Posted: 01.15.2019

By Perri Klass, M.D. Pain control in infants and children has come a long way over the past few decades. Experts know how to provide appropriate anesthesia when children need surgery and understand the ways that even very young children express distress when they’re hurting afterward. There is a lot of evidence about reducing the pain and anxiety that can accompany immunizations and blood draws, and there is increasing expertise about helping children who struggle with chronic pain. But today’s parents may be shocked to learn that was not always the case. As recently as the early 1980s, the pain of children and infants was thought to be different from that of adults and was sometimes treated differently, or sometimes not treated at all. Change doesn’t always come easily in medicine, so there’s a certain onus on parents to make sure that their children get state-of-the-art pain management around procedures, large and small. That means preparation before any planned surgery, ideally with a child life specialist, and it means careful attention to the child’s pain afterward, with parents well backed up by medical specialists. Let me start in the bad old days: About 30 years ago, when I was doing my residency, my 4-year-old son fractured his femur. After surgery, he found himself on the orthopedic ward of my very own hospital, and in a fair amount of pain (the femur is the biggest bone in the body, and there was a lot of tissue damage). As his busybody on-call pediatric resident mother, I discovered that the pain control ordered by the surgeons was “IM MSO4 PRN.” That meant he could have an intramuscular dose of morphine whenever the pain from the fracture was so bad that it overcame a 4-year-old’s fear of shots. To get pain relief, he would have to request the needle. © 2019 The New York Times Company

Keyword: Pain & Touch; Development of the Brain
Link ID: 25854 - Posted: 01.10.2019

Gently stroking a baby reduces activity in their brain associated with painful experiences, a study has found. The study, by University of Oxford and Liverpool John Moores University, monitored the brain activity of 32 babies while they had blood tests. Half were stroked with a soft brush beforehand and they showed 40% less pain activity in their brain. Author Rebeccah Slater said: "Touch seems to have analgesic potential without the risk of side-effects." The study found that the optimal pain-reducing stroking speed was about 3cm (1in) per second. "Parents intuitively stroke their babies at this optimal velocity," said Prof Slater. "If we can better understand the neurobiological underpinnings of techniques like infant massage, we can improve the advice we give to parents on how to comfort their babies." That speed of stroking activates a class of sensory neurons in the skin called C-tactile afferents, which have been previously been shown to reduce pain in adults. But it had been unclear whether babies had the same response or whether it developed over time. "There was evidence to suggest that C-tactile afferents can be activated in babies and that slow, gentle touch can evoke changes in brain activity in infants," said Prof Slater. Prof Slater said the study, published in Current Biology, could explain anecdotal evidence of the soothing power of touch-based practices such as infant massage and kangaroo care, where premature babies are held against the skin to encourage parent-infant bonding and possibly reduce pain. © 2018 BBC.

Keyword: Pain & Touch
Link ID: 25795 - Posted: 12.18.2018

By Kelly Servick If you’ve ever unwittingly grabbed a hot pan, you know our bodies have exquisite reflexes for avoiding or minimizing injuries. But once the damage is done, we also have a spontaneous urge to sooth the pain—to blow on a burned hand, cradle a broken toe, or suck on a cut finger. A new study reveals a neural circuit behind this soothing response in mice. Many common animal tests of pain don’t involve this circuit, the authors contend, which could explain why some painkillers that seem to work in mice prove ineffective in people. “We know there is not just one ‘pain pathway’ or a single brain site involved in processing pain,” says Kathleen Sluka, a neuroscientist at the University of Iowa in Iowa City, who was not involved in the new work. “Understanding the different pathways that underlie unique behaviors could one day help us to individualize treatments” for patients based on how they respond to pain. Harvard University neurobiologist Qiufu Ma and his team wanted to tease apart different aspects of pain, not just in the brain but in the neurons throughout our bodies that relay signals up the spinal cord. Ma and his collaborators previously proposed two general groups of sensory neurons: ones that project to the outermost layer of skin and ones that branch to deeper tissue throughout the body—the underlying skin layers, bones, joints, and muscles. Ma suggests the first group is a first-line defense that monitors our surroundings for danger and prompts us to pull away from a hot pan or a sharp prick. The deeper nerves, he suggests, are attuned to the lasting pain of an injury or illness—and may drive the experience of unpleasantness and distress that comes with pain. Our reflexes avoid potential harm, Ma explains; “the suffering of pain is very different.” © 2018 American Association for the Advancement of Science

Keyword: Pain & Touch
Link ID: 25774 - Posted: 12.11.2018

By Paula Span Shari Horne broke her toes a decade ago, and after surgery, “I have plates and pins and screws in my feet, and they get achy at times,” she said. So Ms. Horne, 66, applies a salve containing cannabidiol, derived from the cannabis, or marijuana, plant. It eases the pain. The salve didn’t help when she developed bursitis in her shoulder, but a tincture of cannabidiol mixed with T.H.C., the psychoactive ingredient in cannabis, provided relief. Using a pipe, she also smokes “a few hits” of a cannabis brand called Blue Dream after dinner, because “I think relaxing is healthy for you.” Many of her neighbors in Laguna Woods, Calif., a community of mostly older adults in Orange County, where she serves on the City Council, have developed similar routines. “People in their 80s and 90s, even retired Air Force colonels, are finding such relief” with cannabis, said Ms. Horne. “Almost everybody I know is using it in one form or another” — including her husband Hal, 68, a retired insurance broker, who says it helps him sleep. In fact, so many Laguna Woods seniors use medical cannabis — for ailments ranging from arthritis and diabetes nerve pain to back injuries and insomnia — that the local dispensary, Bud and Bloom, charters a free bus to bring residents to its Santa Ana location to stock up on supplies. Along with a catered lunch, the bus riders get a seniors discount. Physicians who treat older adults expect their cannabis use to increase as the number of states legalizing medical marijuana keeps growing. After the midterm elections, when Utah and Missouri voters approved medical use, 33 states and the District of Columbia have legalized medical marijuana, along with ten states that also have legalized recreational use. © 2018 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 25761 - Posted: 12.08.2018

By Sarah Vander Schaaff Nancy Baum Lipsitz remembers the night the pain began. She’d had a glass of white wine with a friend and went to bed with a terrible headache. The next day, she still felt horrible, the beginning of what she called a “rolling tide” of near constant migraines and lower level headaches. For three years she dealt with the symptoms. Sometimes she got tunnel vision, or a visual aura, a warning that a big headache was on the way. Those felt like “someone taking a pick and jabbing it through my nose and eye,” she said. Then there was the vomiting, numbness and sensitivity to light and noise. Her speech slurred. Less severe headaches felt like a “hangover.” She stopped exercising, socializing and overseeing her 15-year-old daughter’s homework, relying instead on her daughter to take care of her, bringing an ice pack, medication or whatever else she needed when a migraine attacked. “Everything you are as a human being gets stripped away,” Lipsitz said of what was ultimately diagnosed as refractory migraine. The one thing she did not give up was her work. As director of anesthesiology at Carnegie Hill Endoscopy in New York, she knew patients and staff depended on her. “I am not going to let a migraine shut me in the bedroom,” she said. She showed up at 6 a.m., no matter the pain. © 1996-2018 The Washington Post

Keyword: Pain & Touch
Link ID: 25745 - Posted: 12.03.2018

Exposure to uncomfortable sensations elicits a wide range of appropriate and quick reactions, from reflexive withdrawal to more complex feelings and behaviors. To better understand the body’s innate response to harmful activity, researchers at the National Center for Complementary and Integrative Health (NCCIH), part of the National Institutes of Health, have identified activity in the brain that governs these reactions. Using heat as the source of discomfort, experiments conducted by the center’s intramural program showed that bodily responses to pain are controlled by a neural pathway involving heightened activity in the spinal cord and two parts of the brainstem. Results of the study were published in the journal Neuron. “Much is known about local spinal cord circuits for simple reflexive responses, but the mechanisms underlying more complex behaviors remain poorly understood,” said Alexander T. Chesler, Ph.D., a Stadtman Investigator at NCCIH and senior author of the study. “We set out to describe the brain pathway that controls motor responses and involuntary behaviors when the body is faced with painful experiences.” Just as people respond to increasingly uncomfortable surfaces like a sandy beach on a hot day by lifting their feet, hopping, and eventually running to a water source, so, too, do laboratory models show a predictable sequence of behaviors. Experiments showed that the parts of a brainstem involved in this circuit are the parabrachial nucleus (PBNI) and the dorsal reticular formation in the medulla (MdD). A specific group of nerve cells in the PBNI is activated by standing on a hot surface, triggering escape responses through connections to the MdD. These PBNI cells express a gene called Tac1, which codes for substances called tachykinins that participate in many functions in the body and contribute to multiple disease processes. The MdD cells involved in this circuit also express Tac1. A different group of cells in the PBNI participates in the aspects of the response to noxious heat that involve the forebrain.

Keyword: Pain & Touch
Link ID: 25696 - Posted: 11.17.2018

By Gary Greenberg The Chain of Office of the Dutch city of Leiden is a broad and colorful ceremonial necklace that, draped around the shoulders of Mayor Henri Lenferink, lends a magisterial air to official proceedings in this ancient university town. But whatever gravitas it provided Lenferink as he welcomed a group of researchers to his city, he was quick to undercut it. “I am just a humble historian,” he told the 300 members of the Society for Interdisciplinary Placebo Studies who had gathered in Leiden’s ornate municipal concert hall, “so I don’t know anything about your topic.” He was being a little disingenuous. He knew enough about the topic that these psychologists and neuroscientists and physicians and anthropologists and philosophers had come to his city to talk about — the placebo effect, the phenomenon whereby suffering people get better from treatments that have no discernible reason to work — to call it “fake medicine,” and to add that it probably works because “people like to be cheated.” He took a beat. “But in the end, I believe that honesty will prevail.” Lenferink might not have been so glib had he attended the previous day’s meeting on the other side of town, at which two dozen of the leading lights of placebo science spent a preconference day agonizing over their reputation — as purveyors of sham medicine who prey on the desperate and, if they are lucky, fool people into feeling better — and strategizing about how to improve it. It’s an urgent subject for them, and only in part because, like all apostate professionals, they crave mainstream acceptance. More important, they are motivated by a conviction that the placebo is a powerful medical treatment that is ignored by doctors only at their patients’ expense. And after a quarter-century of hard work, they have abundant evidence to prove it. Give people a sugar pill, they have shown, and those patients — especially if they have one of the chronic, stress-related conditions that register the strongest placebo effects and if the treatment is delivered by someone in whom they have confidence — will improve. Tell someone a normal milkshake is a diet beverage, and his gut will respond as if the drink were low fat. Take athletes to the top of the Alps, put them on exercise machines and hook them to an oxygen tank, and they will perform better than when they are breathing room air — even if room air is all that’s in the tank. Wake a patient from surgery and tell him you’ve done an arthroscopic repair, and his knee gets better even if all you did was knock him out and put a couple of incisions in his skin. Give a drug a fancy name, and it works better than if you don’t. © 2018 The New York Times Company

Keyword: Pain & Touch
Link ID: 25655 - Posted: 11.07.2018

By Ed Silverman, In a highly controversial move, the Food and Drug Administration approved an especially powerful opioid painkiller despite criticism that the medicine could be a “danger” to public health. And in doing so, the agency addressed wider regulatory thinking for endorsing such a medicine amid nationwide angst about overdoses and deaths attributed to opioids. The drug is called Dsuvia, which is a tablet version of an opioid marketed for intravenous delivery, but is administered under the tongue using a specially developed, single-dose applicator. These “unique features” make the medicine well-suited for the military and therefore was a priority for the Pentagon, a point that factored heavily into the decision, according to FDA Commissioner Scott Gottlieb. Although an FDA advisory committee last month recommended approval, the agency was urged by critics not to endorse the drug because it is 10 times more powerful than fentanyl, a highly addictive opioid. Among those who opposed approval were four U.S. senators and the FDA advisory panel chair, who could not attend the meeting, but took the rare step of later writing a letter to the agency. The objections included complaints that Dsuvia has no unique medical benefits and might be easily diverted by medical personnel, despite a risk mitigation plan the manufacturer, AcelRx Pharmaceuticals, must maintain. There was also criticism the FDA failed to convene the Drug Safety and Risk Management Advisory Committee, not just the Anesthetic and Analgesic Drug Products Advisory Committee. Last year, the FDA refused to approve the medicine over concerns about usage directions and a need for additional safety data. © 2018 Scientific American

Keyword: Drug Abuse; Pain & Touch
Link ID: 25642 - Posted: 11.03.2018

Devika G. Bansal Tools that use light, drugs, or temperature to make neurons fire or rest on command have become a mainstay in neuroscience. Thermogenetics, which enables neurons to respond to temperature shifts, first took off with fruit flies about a decade ago, but is emerging as a new trick to manipulate the neural functioning of other model organisms. That’s due to some advantages it affords over optogenetics—the light-based technique that started it all. Genetic toolkits such as thermogenetics and optogenetics follow a basic recipe: scientists pick a receptor that responds to an external cue such as temperature or light, express the receptor in specific neurons as a switch that changes the cell’s voltage—triggering or inhibiting firing—and then use the cue to turn the neural switch on or off. Optogenetics revolutionized our understanding of how the brain’s wiring affects animal behavior. But it comes with drawbacks. For one, delivering light into the deepest regions of the brains of nontransparent animals is a challenge. In mice, this requires surgically inserting optical fibers into the brain, tethering the animal to the light source. Researchers working with adult fruit flies can cut a window through the head cuticle to access the brain. In both cases, the necessary experimental setups are invasive and often time and effort intensive. Additionally, the light intensity required for optogenetics tends to damage tissue. “You pump a lot of light through the optical fiber to activate neurons,” says Vsevolod Belousov, a biochemist at the Russian Academy of Sciences in Moscow who develops thermogenetic tools. “In general, this is not avoidable.” © 1986 - 2018 The Scientist

Keyword: Brain imaging
Link ID: 25636 - Posted: 11.02.2018

By: A. Benjamin Srivastava, M.D., and Mark S. Gold, M.D. T he opioid epidemic is one of the foremost public health crises in the United States. A recent analysis from Stanford University suggested that without any changes in currently available treatment, prevention, and public health approaches, we should expect to have 510,000 deaths from prescription opioids and street heroin from 2016 to 2025 in the US.1 Both the lay press and scientific literature are full of proposals, analyses, and potential solutions. Most focus on expanding access to and dissemination of overdose reversal treatment (naloxone), and the medication-assisted treatment (MAT) drugs methadone, buprenorphine, and naltrexone. Obviously, expanding the availability of naloxone and MAT drugs are important steps that can be readily implemented, especially using an approach similar to what was done during the HIV epidemic.2,3 But in addition to such efforts, we must invest in research to develop new treatments informed by neuroscientific evidence. A comprehensive discussion of naltrexone should be understood within the context of naloxone, which is considered its short-acting version based on relative half-lives (three hours for naloxone, 13 hours for oral naltrexone). When first synthesized, naloxone was a novel medication as well as a cornerstone of research into the pharmacology of the opioid system. Naloxone successfully competes against opioids to bind to the “Mu” opioid receptor on neurons, completely blocking the opioid’s downstream effects. As a “Mu opioid receptor (MOR) antagonist,” it reverses the potentially deadly effects of opioid overdose. © 2018 The Dana Foundation

Keyword: Drug Abuse; Pain & Touch
Link ID: 25609 - Posted: 10.24.2018

Ever wonder why things that normally feel gentle, like putting on soft shirts, are painful after a sunburn? In a study of four patients with a rare genetic disorder, NIH researchers found that PIEZO2, a gene previously shown to control our sense of our bodies in space and gentle touch, may also be responsible for tactile allodynia: the skin’s reaction to injury that makes normally gentle touches feel painful. This and a second NIH-funded study, both published in Science Translational Medicine, used mice to show how the gene may play an essential role in the nervous system’s reaction to injury and inflammation, making PIEZO2 a target for developing precise treatments for relieving the pain caused by cuts, burns, and other skin injuries. “For years scientists have been trying to solve the mystery of how gentle touch becomes painful. These results suggest PIEZO2 is the gene for tactile allodynia. We hope that these results will help researchers develop better treatments for managing this form of pain,” said Alexander T. Chesler, Ph.D., a Stadtman Investigator at the National Center for Complementary and Integrative Health (NCCIH) and a senior author of one of the studies. The PIEZO2 gene encodes what scientists call a mechanosensitive protein which produces electrical nerve signals in response to changes in cell shape, such as when skin cells and neurons of the hand are pressed against a table. Since its discovery in mice by a team led by Ardem Patapoutian, Ph.D., Scripps Research, La Jolla, CA, the lead author of the second paper, scientists have proposed that PIEZO2 plays an important role in touch and pain in humans.

Keyword: Pain & Touch; Genes & Behavior
Link ID: 25563 - Posted: 10.11.2018

Jake Harper Months in prison didn't rid Daryl of his addiction to opioids. "Before I left the parking lot of the prison, I was shooting up, getting high," he says. Daryl has used heroin and prescription painkillers for more than a decade. Almost four years ago he became one of more than 200 people who tested positive for HIV in a historic outbreak in Scott County, Ind. After that diagnosis, he says, he went on a bender. But about a year ago, Daryl had an experience that made him realize he might be able to stay away from heroin and opioids. For several days, he says, he couldn't find drugs. He spent that time in withdrawal. "It hurts all over. You puke, you get diarrhea," Daryl says. His friend offered him part of a strip of Suboxone, a brand-name version of the addiction medication buprenorphine that is combined with naloxone. Buprenorphine is a long-acting opioid that is generally used to treat opioid addiction. It reduces cravings for the stronger opioids he had been taking, prevents physical withdrawal from those drugs and comes with a significantly lower risk of fatal overdose. Daryl injected the buprenorphine, and his opioid withdrawal symptoms disappeared. (Daryl is his middle name, which NPR is using to protect his identity because it is illegal to use buprenorphine without a prescription.) "At first it felt like I was high," Daryl says. "But I think that's what normal feels like now. I have not been normal in a long time." © 2018 npr

Keyword: Drug Abuse; Pain & Touch
Link ID: 25550 - Posted: 10.09.2018

Giorgia Guglielmi A study that claims to show that a homeopathic treatment can ease pain in rats has caused uproar after it was published in a peer-reviewed journal. Groups that promote homeopathy in Italy, where there is currently a debate about how to label homeopathic remedies, have held the study up as evidence that the practice works. But several researchers have cast doubt on its claims. The authors acknowledge some errors flagged in an analysis of the paper by a separate researcher, but stand by its overall conclusions. Senior author, pharmacologist Chandragouda Patil of the R. C. Patel Institute of Pharmaceutical Education and Research in Dhule, India, also says that the results are preliminary and cannot yet be applied to people, and that he hopes that the team’s findings will encourage other researchers to conduct clinical studies. Researchers have presented evidence in support of homeopathy before — famously, in a 1988 Nature paper2 by French immunologist Jacques Benveniste that was later discredited. This latest claim has attracted attention, in part, because it passed peer review at the journal Scientific Reports. (Nature’s news team is editorially independent of its publisher Springer Nature, which also publishes Scientific Reports). © 2018 Springer Nature Limited

Keyword: Pain & Touch
Link ID: 25549 - Posted: 10.09.2018

By Michael Mosley Horizon Could taking a placebo, a pill which contains nothing but ground rice, really help cure back pain? The placebo effect is well studied but at the same time something of a mystery. The word placebo comes from the Latin "I shall please" and is associated with images of quack doctors selling dodgy cures. Yet it is also an important part of modern clinical trials, where patients are given either a placebo (sometimes called a dummy pill) or an active drug (without knowing which is which) and researchers then look to see if the drug outperforms the placebo, or vice versa. But what if you decided to do a placebo-controlled trial on back pain, with a twist? The twist being that everyone, unknowingly, was getting placebo? Would people taking the pills get better anyway? That's what we set out to test for BBC2's Horizon programme, Can my brain cure my body? With the help of Dr Jeremy Howick. an expert on the placebo effect from University of Oxford, we set out to see if we could cure real back pain with fake pills. It would be the largest experiment of its kind ever carried out in the UK, with 100 people from Blackpool taking part. Some were asked to act as a "control" group. The rest were told that they were taking part in a study - where they might receive the placebo or a powerful new painkiller. What they weren't told was that they would all get placebos, capsules containing nothing but ground rice. The pills were authentic looking and based on years of research. They were blue-and-white-striped, because that has been shown to have a greatest painkilling effect. They came in bottles, carefully labelled, warning of potential side effects and sternly reminding patients to keep out of the hands of children. All very convincing. © 2018 BBC

Keyword: Pain & Touch
Link ID: 25525 - Posted: 10.04.2018

By Ersilia M. DeFilippis I felt a shake and opened my eyes. The clock read 1:30 a.m. “We need to go to the hospital,” my mother whispered in my ear, clutching her stomach. She knew; it was the same pain she had experienced many times before. We were in California, many miles from home, many miles from my father (a doctor), who always knew what to do. At the time, I was early in my medical school training, although I knew all the intricate details of my mother’s medical history and realized she needed to get medical attention. When we arrived at the local emergency room in an affluent neighborhood, my mother was placed in a wheelchair and taken to the waiting room. She curled up on the cold barren hospital floor, the only position she could find comfortable. Although my mother usually puts on lipstick and high heels to go to the grocery store, this time, her hair was unkempt and her pajamas worn out. Her knees were tucked into her chest and her belly was distended. It should have been clear to onlookers that she was in agonizing pain, but people were hesitant, skeptical even. “Ma’am,” someone yelled. “Ma’am, we can’t have you lying on the floor. Get up.” My mother lay still. “Get up, ma’am,” she was told again, again more forcibly. They helped her back into the wheelchair. “Help me,” she said. “The pain is unbearable.” Reluctantly, they put her in a stretcher and prepared to place an IV in her arm. To convince them the pain was real, we asked them to call my father, who could fill in all of the medical details: her multiple prior hospitalizations, surgeries and diagnoses. © 1996-2018 The Washington Post

Keyword: Pain & Touch
Link ID: 25511 - Posted: 10.01.2018