by Donald Rogers, Pharm.D., BCPS With the help of the National Pharmaceutical Council and the Joint Commission on Accreditation of Healthcare Organizations (2001), pain management has exploded into the 21st century. Such entities have confirmed that pain should be monitored as the fifth vital sign and that the assessment, treatment and monitoring of pain should be available to every patient, despite their social, economic or cultural background. Any institution that fails to do so runs the risk of not being accredited by such organizations. Although close in proximity within the English dictionary, pain and psychiatry are two terms not often thought of in the same sentence. As pain clinics and pain teams emerge in attempts to meet the requirements of accrediting agencies, many fail to address or even acknowledge the psychiatric component of pain. As a result, psychiatrists are often left out of the equation. Furthermore, many practitioners question the role that a psychiatrist would play in the treatment of pain or feel it is outside the psychiatrist's scope of practice. After all, what would a psychiatrist know about the treatment of osteoarthritis, postherpetic neuralgia or fibromyalgia? Based on such premises, this article will serve multiple purposes. First, it will present the reader with a compelling argument for the inclusion of psychiatry in pain management. It will also present data supporting the need to rule out pain-related syndromes in the psychiatric setting. A brief review of terminology will familiarize the reader with the classification of pain. Two sections will then present the medical approach and potential psychiatric interventions to pain management. The latter will emphasize what the psychiatrist needs to accomplish to make sure the patient is treated as a whole. Finally, pharmacologic treatment alternatives and potential interactions with medical medications will be reviewed.

Keyword: Pain & Touch
Link ID: 6161 - Posted: 09.28.2004

Chronic use of opiate drugs may alter brain neurons to make animal brains more sensitive to stress, according to a new study. If the research proves applicable to humans, the findings may help explain how hospital patients who have received morphine may be susceptible to stress disorder, attention problems and sleep disturbances. The effects on the brain may also contribute to better understanding of drug addiction. The study, published in the September 22 issue of the Journal of Neuroscience, was the first to show that chronic opiate use disrupts the stress response of nerve cells in the noradrenergic system. This system, using a neurotransmitter called norepinephrine, influences the brain's arousal and attention levels when a stressful event occurs. The researchers observed that the norepinephrine neurons of rats that had received morphine infusions for a week discharged more frequently in response to a stressor, compared to neurons of rats that had not received morphine. "The increase in neuron firing indicated the neurons were more sensitive to stress, and we also found this sensitization translated into behavioral changes--as shown in the rats' swimming behavior," said study leader Rita J. Valentino, Ph.D., a behavioral neuroscientist at The Children's Hospital of Philadelphia.

Keyword: Drug Abuse; Stress
Link ID: 6160 - Posted: 09.28.2004

Drum the tip of a finger on a typewriter key quickly "eeeeee." Now, stop and type "e" take a moment, type "e," take another moment, type "e" again. The motion in both cases is exactly the same, performed by the same finger. But the brain processes that make the two different streams of 'e's are utterly different, according to a study done by a University of Southern California neural specialist and colleagues. The insight may lead to, among other things, better movement control by humanoid robots, but also new ways of movement rehabilitation. And perhaps it even offers some insight into the effect of music. Dr. Stefan Schaal, an associate professor in the computer science department of the USC Viterbi School of Engineering led the international team that used functional Magnetic Resonance Imaging (fMRI) scans to test a longstanding question regarding "rhythmic" versus "discrete" movement. "Rhythmic movements like walking, chewing or scratching are found in many organisms, ranging from insects to primates," notes Schaal in an article published in Nature Neuroscience Sept. 26. "In contrast, discrete movements like reaching and kicking are behaviors that have reached sophistication in young species, particularly in primates."

Keyword: Biomechanics
Link ID: 6159 - Posted: 09.28.2004

DES MOINES, Iowa - Azy and Indah are heading to school this week — a unique experience for two clever orangutans whose classroom will eventually encompass more than 200 acres of lowlands, river forest and lakes. On Tuesday, the inquisitive primates will become the first residents of the Great Ape Trust of Iowa. While there, researcher Rob Shumaker and a team of scientists will study the behavior and learning capabilities of the apes. Azy, 26, and Indah, 24, who are brother and sister, have never lived in the wild. They were born at the National Zoo in Washington, D.C., where they have been part of a research program, the Orangutan Language Project, since 1995. Shumaker developed the program, which allows the long-haired apes to communicate by selecting symbols on a computer monitor. "The opportunities that lie ahead for them and this world-class research center are limitless," said Shumaker, the trust's director of orangutan research. Construction of the Great Ape Trust began in 2003 at the site of a former sand and gravel quarry. Besides orangutans, the Des Moines campus also will house bonobos, chimpanzees and lowland gorillas. Some consider the site the most comprehensive ape research facility in the world. Copyright © 2004 Yahoo! Inc.

Keyword: Language; Evolution
Link ID: 6158 - Posted: 06.24.2010

By Harvey McGavin Fortifying foods such as flour and pasta with folic acid could significantly reduce the likelihood of babies being born with disabilities such as spina bifida, a study shows. The number of babies with neural tube defects, brain or spine abnormalities, has fallen by more than 75 per cent in Newfoundland and Labrador since a law forced fortification of staple foods with folic acid. Women who take folic acid supplements while trying to conceive reduce the risks of having a baby with neural tube defects. The Food Standards Agency advises a daily supplement of 400 micrograms. Folic acid occurs naturally in green leafy vegetables, brown rice, yeast extract, oranges and bananas. More than 30 countries already decree fortification of food products, leading to a fall in the number of babies being born with defects. In Newfoundland and Labrador, folic acid has been added to all flour, cornmeal and pasta since 1998. Researchers found the proportion of babies born with neural tube defects in the province has fallen by 78 per cent in six years. ©2004 Independent Digital (UK) Ltd.

Keyword: Development of the Brain
Link ID: 6157 - Posted: 06.24.2010

By ANDREW POLLACK Merck & Company has obtained rights to license an experimental drug to treat obesity that has generated scientific interest because it is based on a hormone used by the body to signal that it has eaten enough. The rights are from the Nastech Pharmaceutical Company, which has developed a nasal spray incorporating the hormone. The two companies are expected to announce the deal today. The drug is now in the earliest stages of clinical trials, meaning that, if found to be effective, it would probably take several years to become available to consumers. The spray incorporates peptide YY 3-36, or PYY for short. It is a hormone made by the small intestine that is sent to the brain to signal satiety. There is some evidence that obese people make less of this hormone than leaner people, suggesting that their brains might be receiving only a weak signal to stop eating. In one small experiment, published in The New England Journal of Medicine last year, both obese and lean volunteers received a single intravenous infusion of the hormone. At a buffet lunch later that day, they ate 30 percent less than those who received a placebo. Copyright 2004 The New York Times Company

Keyword: Obesity
Link ID: 6156 - Posted: 09.27.2004

By Matthew Chapman The government is to investigate claims that increasing numbers of parents of children with Asperger's Syndrome are being falsely accused of abuse. The investigation follows revelations by BBC Five Live. It is estimated around 48,000 children in Britain could have Asperger's, a condition under which patients can have high IQs, but lack social skills. Experts fear some local authorities misrepresent outwardly odd behaviour and suspect parents of abuse. Those holding that view include Professor Simon Baron-Cohen, of Cambridge University. He says some councils have "turned the clock back 50 years" in their investigations of children with the syndrome. Professor Baron-Cohen said: "It has come to my attention that an increasing number of parents of children with Asperger's are being regarded with suspicion when their child shows behavioural problems at school." He said that books such as last year's bestseller "The Curious Incident of the Dog in the Night Time" had increased awareness of the condition. "This increase in recognition though has revealed that schools and social services have been mis-recognising it and putting it down to bad parenting," he added. He has now written a set letter for parents of Asperger's children involved in abuse allegations to give to social services to explain the syndrome. Large numbers of worried parents have also been contacting charities such as the National Autism Society, which is currently helping a mother accused of Munchausen's By Proxy, a controversial diagnosis where mothers are accused of deliberately harming their own children. (C)BBC

Keyword: Autism
Link ID: 6155 - Posted: 09.27.2004

Vitamin E can help restore hearing in people who become deaf suddenly for no known reason, research suggests. This natural antioxidant has already been hailed as a potential cancer therapy by preventing or slowing damage caused by certain oxygen compounds. A study of 66 patients with sudden hearing loss, by the Technion-Israel Institute of Technology, found those given vitamin E made the best recovery. The work was presented at an Ear, Nose and Throat surgery meeting in New York. About 123,000 people in the UK experience sudden so-called "sensorineural" hearing loss. In most cases, the cause is known. The culprit can be a viral or bacterial infection or trauma, for example. However, in about 10-15% of cases there is no obvious cause and this is called idiopathic sensorineural hearing loss. About two-thirds of people with idiopathic hearing loss will recover within days without treatment, but the others do not. All of the patients involved in the study had been admitted to hospital within the previous eight days for sudden hearing loss of an unknown cause. All were given standard treatment, which included bed rest, steroid drugs and a mixture of carbon and oxygen gas by a mask. (C)BBC

Keyword: Hearing
Link ID: 6154 - Posted: 09.25.2004

By Alex Kirby The world's oceans are now so saturated with noise that whales and other marine mammals are dying, biologists say. The UK's Whale and Dolphin Conservation Society is launching a campaign, Oceans of Noise, to tackle what it says is the increasing problem of noise pollution. It says key sources of undersea noise are the search for oil and gas, and the use of low-frequency military sonars. The WDCS is proposing an action plan to regulate submarine noise pollution, and says a worldwide treaty may be needed. It says there is evidence that noise is causing hearing loss in cetaceans (whales, dolphins and porpoises), injuring them and causing them to strand themselves, and is sometimes killing them. It also believes excessive noise is seriously interfering with cetaceans' ability to communicate with each other. The WDCS says the frequency ranges of some noise sources of human origin may be blotting out other, biologically important sounds, preventing mothers and calves from staying in touch and masking sound cues for predators and their prey. It says: "Flight, avoidance or other changes in behaviour have been observed in cetaceans from tens to hundreds of kilometres from the noise sources. (C)BBC

Keyword: Hearing
Link ID: 6153 - Posted: 09.25.2004

Few have heard of the degenerative, deadly disease called Ataxia-telangiectasia (A-T) but a University of Alberta researcher is hoping to provide clues to this mysterious disorder. Dr. Shelagh Campbell, from the U of A's Department of Biological Sciences, is a basic researcher who studies how normal cell cycles are regulated, by analyzing genes that are responsible for repairing DNA damage that offer insights into human diseases like cancer and A-T. A-T is a progressive, degenerative disease that affects a startling number of body systems. Children with A-T appear normal at birth but at around the age of two, some of the first signs--walking and balance is wobbly caused by ataxia or lack of muscle control--start appearing. "Kids are often misdiagnosed with cerebral palsy but what distinguishes A-T is it gets worse," said Campbell. "Sadly, many of the people with A-T end up in wheelchairs and most die young (I think there is a fair range).

Keyword: Movement Disorders
Link ID: 6152 - Posted: 09.25.2004

Emma Marris Tibetan mothers have provided anthropologists with a prime example of ongoing human evolution. Researchers have found that women who are able to store more oxygen in their blood have more offspring that live to maturity. Cynthia Beall, a physical anthropologist at Case Western Reserve University in Cleveland, Ohio, and colleagues travelled to the Himalayas to see if they could catch the population there in the act of adapting to the low levels of oxygen found at 4,000 metres. Beall and her team lived in a series of villages, interviewing thousands of inhabitants, creating detailed family trees and, for women between 20 and 60, recording pregnancy histories. They also estimated the concentration of oxygen in the villagers' blood, by shining a light through their fingertips. Haemoglobin in the blood absorbs different amounts of the light, depending on how saturated it is with oxygen. Once non-genetic factors such as age, illness, or smoking were removed, a subset of the group seemed to have a blood-oxygen concentration that was 10% higher than normal. This trait was inherited in a way that suggested the difference was due to a single gene. ©2004 Nature Publishing Group

Keyword: Evolution
Link ID: 6151 - Posted: 06.24.2010

Susan Milius A Tasmanian company has developed a poppy that produces a commercially useful drug precursor instead of full-fledged morphine, and an international research team has now reported how the plant does it. The top1 mutant of the opium poppy (Papaver somniferum) came out of a company research effort in 1995, but scientists haven't previously published studies of this mutant, says Philip Larkin of the plant-industry section, in Canberra, of CSIRO, Australia's federally funded research agency. In the top1 mutant, the poppy's natural chemistry has a glitch that stops the normal process of making morphine, which is prized as a drug by itself and as a raw material for opiates such as heroin. As a consequence of the synthetic pathway's breakdown, top1 accumulates two intermediate compounds: thebaine and oripavine. To make some modern painkillers and addiction treatments, pharmaceutical companies convert morphine back to thebaine and then process it further. Starting with thebaine is more efficient, Larkin says. The Tasmanian drug industry has been using top1 since 1998 for production of buprenorphine, oxycodone, naloxone, and naltrexone. Copyright ©2004 Science Service.

Keyword: Pain & Touch
Link ID: 6150 - Posted: 06.24.2010

The likelihood of a person committing suicide is partly determined as early as at birth, researchers believe. The Swedish team looked at 700,000 adults and found low birthweight and being born to a teenage mother meant a two-fold rise in suicide risk. The report also said risk increased for shorter babies. The authors, from the National Centre for Suicide Research and Prevention in Stockholm, said it proved genetics played an important role in suicides. The researchers followed the adults, who were all born between 1973 and 1980, and assessed the proportion of suicides and attempted suicides between 10 and 26 years of age. The overall suicide rate in Sweden in 1999, when the follow-up exercise finished, was around 20 per 100,000 of the population. Babies weighing 2kg or less were more than twice as likely to commit suicide as adults than those weighing between 3.25kg and 3.75kg, according to the findings published in The Lancet medical journal. Children born to mothers under 19 years old were also more than twice as likely to commit suicide as those born to women aged 20 to 29. (C)BBC

Keyword: Depression; Development of the Brain
Link ID: 6149 - Posted: 09.24.2004

The door to apartment 2F looked like any other. But what lay inside was a shocking sight: Mounds of garbage and trash so tall and so plentiful that there was almost no way to open the front door. "There was a huge table there piled high with stuff and there was a tiny little path. In some places you had to sneak by it sideways," says Ron Alford who runs Disaster Masters, Incorporated www.theplan.com , a company dedicated to helping extreme pack rats clean house. "Stuff was just stacked up and the cockroaches were walking up behind it and making a mess on the wall." After an 85-year-old man broke his leg tripping over the clutter, his family called Alford, who with a crew of six men and women waded through an apartment packed full of old roller skates, radio parts and airplane model material. Nearly three days later, the carpets and floors began to see daylight. Alford has a special word he coined to describe such hoarding behavior: disposophobia. "When you trip and fall on your own stuff, when you're ashamed or afraid to have your friends, relatives or neighbors come into your house and sit down, that's how we draw the line," he says. "Your life has become abysmal because the stuff is overruling your life." © ScienCentral, 2000- 2004.

Keyword: Miscellaneous
Link ID: 6148 - Posted: 06.24.2010

Like estrogen loss in older women, decreased levels of testosterone may put aging men at risk for Alzheimer's disease, according to a new study by USC researchers. The team's findings – appearing as a letter to the editor in the Sept. 22 issue of the Journal of American Medical Association – bolster sparse research on the adverse effects of age-related testosterone depletion in the brain and may lead to future development of hormone replacement therapies. "Our findings strongly suggest that normal age-related testosterone depletion is one of the important changes that promote Alzheimer‚s disease in men," said Christian Pike, senior author of the study and an assistant professor at the USC Leonard Davis School of Gerontology. "Understanding how these changes increase vulnerability to the disease is critical not only for elucidating Alzheimer's development, but also for identifying those persons most at risk," Pike said. While the link between estrogen loss in women and increased susceptibility to a variety of diseases – including Alzheimer's – has long been well established, there has been less focus on the health effects of hormonal depletion in men.

Keyword: Alzheimers; Hormones & Behavior
Link ID: 6147 - Posted: 06.24.2010

Mating with close relatives often leads to no good, so most animals try to avoid it. So pity the female red jungle fowl. With randy and aggressive brethren, they don't have much choice when it comes to mates. But the hens can avoid the ill effects of inbreeding by picking which sperm fertilize their eggs, scientists have discovered. Among promiscuous animals, males and females may have conflicting strategies when it comes to inbreeding. Because males can produce many sperm fairly cheaply, it's no great loss if mating with their mother or sister happens to yield a few bad eggs. But for females, producing eggs requires more effort and they ought to strenuously avoid inbreeding. In the promiscuous red jungle fowl Gallus gallus, the wild progenitor of domestic chickens, the risk of inbreeding is high because hens and cocks stay close to their home turf. Smaller female jungle fowl can do little to resist incest. But because they can store sperm, females may be able to choose whose sperm wins their egg. Copyright © 2004 by the American Association for the Advancement of Science.

Keyword: Sexual Behavior; Evolution
Link ID: 6146 - Posted: 06.24.2010

DURHAM, N.C. -- Neurobiologists have pinpointed the molecular storehouse that supplies the neurotransmitter receptor proteins used for learning-related changes in the brain. They also found hints that the same storage compartments, called recycling endosomes, might be more general transporters for 'memory molecules' used to remodel the neuron to strengthen its connections with its neighbors. They said their finding constitutes an important step toward understanding the machinery by which neurons alter their connections to establish preferred signaling pathways in the process of laying down new memories. Understanding such machinery could also offer clues to how it might degenerate in aging and disease to degrade learning and memory, they said The researchers, led by Michael Ehlers of the Duke University Medical Center and Julie Kauer of Brown University, published their findings in the September 24, 2004, issue of the journal Science. Other co-authors on the paper were Mikyoung Park of Duke, and Esther Penick, Jeffrey Edwards of Brown. Their research was supported by the National Institutes of Health. In their studies, the researches sought to understand how neurotransmitter receptors in the depths of the neuron are carried to the surface -- a process called exocytosis. These receptors are proteins that are activated by bursts of signaling chemicals, called neurotransmitters, launched from another, transmitting neuron. The connection between transmitting and receiving neurons is called the synapse.

Keyword: Learning & Memory
Link ID: 6145 - Posted: 09.24.2004

A handful of genes in a morphine free poppy could hold the key to producing improved pain management pharmaceuticals. Norman, the 'no-morphine' poppy, is superior to morphine producing poppies as it produces thebaine and oripavine – compounds preferred by industry in the manufacture of alternative high value pain-killers. CSIRO's Dr Phil Larkin, and The Australian National University's Anthony Millgate and Dr Barry Pogson have been working with Tasmanian Alkaloids to investigate Norman the morphine-free poppy. "The genes we found behaved differently in Norman compared to standard morphine producing poppies and were consistently associated with the blockage in morphine synthesis and with the accumulation of thebaine and oripavine," Dr Larkin says. "Understanding the genes responsible for the production of morphine, thebaine and oripavine is an important step in further developing poppies that are tailored to produce alternative pharmaceuticals." The morphine free poppy variant, TOP1, was first discovered in 1995 by Tasmanian Alkaloids then released as Norman for commercial production in 1997 in Tasmania where it is now widely grown.

Keyword: Pain & Touch
Link ID: 6144 - Posted: 06.24.2010

Dog walkers know the canine habit of sniffing lampposts for urine only too well. Now, in a novel experiment, a team of scientists and dog trainers have put this traditional canine behaviour to good use – sniffing human urine to detect bladder cancer sufferers. The researchers hope that analysis and identification of the characteristic chemical odorants may lead to non-invasive, early-detection screening methods for bladder cancer in the future. “There had been a series of anecdotal stories about patients whose pet dogs had aroused concern by continually sniffing their moles, which actually turned out to be cancerous. I was pretty sceptical and needed to design a simple experiment to test it,” explained the study’s lead author, Carolyn Willis, from Amersham Hospital in the UK. The impracticalities of training dogs to detect skin cancer using skin biopsies led Willis and colleagues to consider trying bladder cancer detection, using easily obtainable urine samples. The group used urine samples from 36 patients with bladder cancer, and 108 control samples from cancer-free individuals. Six dogs of varying ages and breeds underwent a seven month training course in cancer detection, carried out by trainers from Hearing Dogs for the Deaf. © Copyright Reed Business Information Ltd.

Keyword: Chemical Senses (Smell & Taste)
Link ID: 6143 - Posted: 06.24.2010

Rats equipped with radios that transmit their brainwaves could soon be helping to locate earthquake survivors buried in the wreckage of collapsed buildings. Rats have an exquisitely sensitive sense of smell and can crawl just about anywhere. This combination makes them ideal candidates for sniffing out buried survivors. For that, the animals need to be taught to home in on people, and they must also signal their position to rescuers on the surface. In a project funded by DARPA, the Pentagon’s research arm, Linda and Ray Hermer-Vazquez of the University of Florida in Gainesville have worked out a way to achieve this. First the researchers identified the neural signals rats generate when they have found a scent that they are looking for. “When a dog is sniffing a bomb, he makes a unique movement that the handler recognises,” says John Chapin, a neuroscientist at the State University of New York in Brooklyn who is collaborating on the project. “Instead of the rat making a conditioned response, we pick up the response immediately from the brain.” © Copyright Reed Business Information Ltd.

Keyword: Chemical Senses (Smell & Taste)
Link ID: 6142 - Posted: 06.24.2010