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

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Giorgia Guglielmi People who have low-risk surgery in Canada and the United States fill prescriptions for opioid painkillers at nearly seven times the rate seen in Sweden, according to recent research1. Studying these differences could help nations such as the United States to develop prescribing guidelines to counteract the surge in opioid use that is devastating some communities, say the study authors. The findings, which are published on 4 September in JAMA Network Open, are the first to quantify the differences in opioid use for people who had similar types of surgery across countries. There’s anecdotal evidence that clinicians tend to prescribe more opioids after surgery in some countries than in others, says Mark Neuman, an anaesthesiologist at the University of Pennsylvania in Philadelphia, who led the study. And over-prescription of opioids is associated with an increased risk of developing long-term dependence and addiction, he says. To investigate further, Neuman and his team gathered prescription data from between 2013 and 2016 from Canada, the United States and Sweden. The countries all have similar levels of surgical care as well as detailed data on opioid prescriptions. The team found that nearly 79% of people in Canada and about 76% of those in the United States who had one of 4 operations — and who filled their opioid prescriptions — did so within 7 days of leaving hospital, compared with 11% of people in Sweden (see ‘Painkiller prescriptions’). “That’s a striking difference,” says Gabriel Brat, a surgeon at Beth Israel Deaconess Medical Center in Boston, Massachusetts. The procedures were removals of the gallbladder, appendix, breast lumps or meniscus cartilage in the knee. © 2019 Springer Nature Publishing AG

Keyword: Drug Abuse; Pain & Touch
Link ID: 26590 - Posted: 09.09.2019

Patti Neighmond The pathway to opioid abuse for women often starts with a prescription from the doctor's office. One reason is that women are more likely than men to seek help for pain. Pain researchers say that not only do women suffer more painful conditions, they actually perceive pain more intensely than men do. "The burden of pain is substantially greater for women than men," says researcher and psychologist Roger Fillingim, "and that led pain researchers like myself to wonder if the pain perception system is different in women than in men." For more than two decades, Fillingim has been studying gender differences and pain, most recently at the University of Florida's Pain Research and Intervention Center of Excellence, where he is director. He recruits healthy male and female volunteers to take part in experimental pain sessions using various painful stimuli, including pressure, heat, cold and electrical stimulation. Probes are typically applied to the hand or arm. As intensity of the stimuli is increased, volunteers are asked to rate their pain on a scale of zero to 10, where zero is no pain and 10 is the most intense pain one can imagine. If volunteers report pain levels at 10, Fillingim stops the experiment immediately. "On average, women report the same stimuli to be more painful than men," Fillingim says, emphasizing that the same stimulus is applied to everybody, so if there are differences in how painful the experience is, it can't be because of the stimulus because it's calibrated to be the same for all. © 2019 npr

Keyword: Pain & Touch; Sexual Behavior
Link ID: 26546 - Posted: 08.27.2019

/ By Lola Butcher Like all primary care physicians, Danielle Ofri sees a lot of aching backs. Low back pain is one of the top five reasons people visit the doctor, and based on extensive experience, Ofri knows how the conversations will go. Patients want relief from miserable pain, so they want an imaging study. “I want to see what’s going on — that’s what they say,” says Ofri, who treats patients at Bellevue Hospital in Manhattan. The easy thing to do is order a scan and send them home to wait for the results. The right thing to do, in the vast majority of cases, is to deliver the bad news: They need to wait for the pain to subside on its own, which may mean a few weeks of agony. In the meantime, if possible, it’s best to stay active and limit bed rest. An over-the-counter pain reliever might help. Unless certain symptoms point to a more serious problem, the physician shouldn’t order any imaging within the first six weeks of pain. On this last point, medical guidelines are remarkably clear and backed by studies demonstrating that routine imaging for low back pain does not improve one’s pain, function, or quality of life. The exams are not just a waste of time and money, physician groups say; unnecessary imaging may lead to problems that are much more serious than back pain. And yet, between 1995 and 2015, magnetic resonance imaging (MRI) and other high-tech scans for low back pain increased by 50 percent, according to a new systematic review published in the British Journal of Sports Medicine. According to a related analysis, up to 35 percent of the scans were inappropriate. Medical societies have launched campaigns to convince physicians and patients to forgo the unnecessary images, but to little avail. Copyright 2019 Undark

Keyword: Pain & Touch; Brain imaging
Link ID: 26540 - Posted: 08.26.2019

Scott Hensley At some point nearly everyone has to deal with pain. How do Americans experience and cope with pain that makes everyday life harder? We asked in the latest NPR-IBM Watson Health Poll. First, we wanted to know how often pain interferes with people's ability to work, go to school or engage in other activities. Overall, 18% of Americans say that's often a problem for them. Almost a quarter – 24% — say it's sometimes the case. The degree to which pain is a problem varies by age, with 22% of people 65 and older saying pain interferes often with their daily lives compared with only about 9% of people 35 and younger. Once pain strikes, how do people deal with it? The poll found that 63% of people had sought care for their pain and 37% hadn't. Younger people were less likely to have pursued care. The most common approach is an over-the-counter pain reliever. Sixty percent of people said that is something they do. Another popular choice, particularly among younger people, is exercise, including stretching and yoga. Forty percent of those under 35 say exercise is a way they seek relief. Only 11% of people 65 and older say exercise is something they try for pain. Overall, 26% of people see exercise as helpful for their pain. That level of exercise is "really exciting to see," says Brett Snodgrass, a nurse practitioner and clinical coordinator of palliative medicine at Baptist Health Systems in Memphis, Tenn. In her experience, not nearly as many people were doing that, even a few years ago. © 2019 npr

Keyword: Pain & Touch; Drug Abuse
Link ID: 26532 - Posted: 08.23.2019

Nicola Davis A new organ involved in the sensation of pain has been discovered by scientists, raising hopes that it could lead to the development of new painkilling drugs. Researchers say they have discovered that the special cells that surround the pain-sensing nerve cells that extend into the outer layer of skin appear to be involved in sensing pain – a discovery that points to a new organ behind the feeling of “ouch!”. The scientists say the finding offers new insight into pain and could help answer longstanding conundrums. “The major question for us now is whether these cells are actually the cause for certain kinds of chronic pain disorders,” Prof Patrik Ernfors, a co-author of the research from the Karolinska Institute in Sweden, told the Guardian. Writing in the journal Science, the researchers reveal how they examined the nature of cells in the skin that, they say, have largely been overlooked. These are a type of Schwann cell, which wrap around and engulf nerve cells and help to keep them alive. The study has revealed these Schwann cells have an octopus-like shape. After examining tissues, the team found the body of the cells sits below the outer layer of the skin, but that the cells have long extensions that wrap around the ends of pain-sensing nerve cells that extend up into the epidermis, the outer layer of the skin. The scientists were surprised at the findings because it has long been believed that the endings of nerve cells in the epidermis were bare or unwrapped. “In the pain field, we talk about free nerve endings that are responsible for pain sensation. But actually they are not free,” Ernfors said. © 2019 Guardian News & Media Limited

Keyword: Pain & Touch; Glia
Link ID: 26507 - Posted: 08.16.2019

By Sandra G. Boodman Galen Warden was lying in a hot bath after a punishing week at her demanding marketing job. Her neck and shoulders were, as usual, in knots, so Warden thought she’d expedite the relaxation that a restorative soak usually delivered by sliding under the water. When she sat up about 30 seconds later, Warden recalled, “it felt like my entire scalp was on fire.” Her face, neck and shoulders were unaffected, but her scalp felt as though it had been doused with acid. It would take nearly three months before the cause of Warden’s unusual symptom, which was repeatedly attributed to a tension headache, was revealed. During that time, the emergence of other symptoms failed to prompt the specialist treating her to reconsider her initial diagnosis. If anything, the new problems seemed to harden the doctor’s conviction that Warden’s problem was stress-related. Looking back, Warden said she is struck by what she characterizes as her medical naivete. "It's been a cautionary tale for my friends," she said. "I can't believe I kept going back to a well that was dry." Shocked by the fiery sensation engulfing her scalp, Warden turned on the shower and ran cool water over her head, frantically trying to think about what might have triggered it. She hadn’t rubbed her scalp hard or used a different shampoo or bath product. © 1996-2019 The Washington Post

Keyword: Pain & Touch
Link ID: 26485 - Posted: 08.12.2019

Anna Ploszajski A man who lost his hand 17 years ago has been given the sense of touch through a brain-controlled robotic prosthetic. Keven Walgamott, whose arm was amputated below the elbow after an accident, can now feel 119 different touch sensations through the prosthetic as if it were his own limb. He is able to distinguish between large, small, soft and hard objects when blindfolded, and handle delicate objects such as grapes and eggs. Everyday tasks such as putting on his wedding ring, peeling a banana or holding a mobile phone are now possible. “The most amazing thing for me is what the team was able to do,” said Walgamott. “[They] take a bunch of mechanical pieces and provide, through a computer, not only the ability to move all fingers and grasp things but be able to feel again.” The prosthetic hand and wrist has been in development for 15 years. Electrodes were implanted in the remaining part of his arm, allowing communication between the prosthetic hand and his brain. The hand can move in six directions and is equipped with 19 sensors that detect touch and positioning. The arrays interpret the signals Walgamott’s brain sends to his arm nerves, and a computer outside the body translates these into digital information, which then instructs the prosthetic to move as the wearer intends. They also provide Walgamott’s nerves with computer-generated touch signals from the prosthesis, which are then interpreted by his brain. © 2019 Guardian News & Media Limited

Keyword: Pain & Touch; Robotics
Link ID: 26449 - Posted: 07.25.2019

Shuai Xu, Arun Jayaraman and John A. Rogers. Thin, soft electronic systems that stick onto skin are beginning to transform health care. Millions of early versions1 of sensors, computers and transmitters woven into flexible films, patches, bandages or tattoos are being deployed in dozens of trials in neurology applications alone2; and their numbers growing rapidly. Within a decade, many people will wear such sensors all the time. The data they collect will be fed into machine-learning algorithms to monitor vital signs, spot abnormalities and track treatments. Medical problems will be revealed earlier. Doctors will monitor their patients’ recovery remotely while the patient is at home, and intervene if their condition deteriorates. Epidemic spikes will be flagged quickly, allowing authorities to mobilize resources, identify vulnerable populations and monitor the safety and efficacy of drugs issued. All of this will make health care more predictive, safe and efficient. Where are we now? The first generation of biointegrated sensors can track biophysical signals, such as cardiac rhythms, breathing, temperature and motion3. More advanced systems are emerging that can track certain biomarkers (such as glucose) as well as actions such as swallowing and speech. Small companies are commercializing soft biosensor systems that measure clinical data continuously. These include Vital Connect in San Jose, California; iRhythm in San Francisco, California; MC10 in Lexington, Massachusetts; and Sibel Health in Evanston, Illinois. For example, iRhythm’s single-use Zio patch monitors electrical pulses from the heart for 14 days, and is more effective than intermittent hospital check-ups at detecting abnormal rhythms4. But it is bulky and temporary, and the data must be downloaded after use, rather than transmitted in real time.

Keyword: Pain & Touch; Robotics
Link ID: 26425 - Posted: 07.18.2019

Mike Power Roll up, roll up, ladies and gentleman, and gather around. Do you, your loved one – or family pet – suffer from any of the following conditions? Cancer, epilepsy, diabetes, arthritis, anxiety, menstrual cramps, insomnia, dry skin, psychosis, Alzheimer’s, dementia, anger, depression, ADHD, Crohn’s and IBS, PTSD, opiate addiction, Parkinson’s, pain of any kind, migraine, or canine uptightness? Then it’s your lucky day. All can be treated, claim the snake oil salesmen of the modern wild west, with the miracle cure-all: CBD, or cannabidiol. It’s one of the 119 cannabinoids contained in cannabis sativa, indica and ruderalis, and all hybrids thereof; aka weed. CBD is legal and doesn’t get you high – still-illegal cannabinoid THC does that job very efficiently – but it’s fair to say business is blazing. What a giddy array of products there are: from CBD water (sold in clear bottles that mean the sensitive compound swiftly degrades), to cooking or massage oils, pills, chewing gum, transdermal patches, pessaries, gin, beer and lube. The crown for silliest CBD product of the year, however, belongs indisputably to the CBD-infused pillowcases sold by one hopeful firm of US fabric-makers. Yoga classes offering CBD-assisted asanas and guided meditation have sprung up, with devotees claiming greater flexibility and elevated mood. Sellers in the UK are careful not to claim any specific medical benefits for the products because of a lack of clinical evidence, so they are instead marketed as food supplements. In this, they are supported by breathless, uncritical media reports on CBD use for airily unspecified “wellbeing” purposes. © 2019 Guardian News & Media Limited

Keyword: Drug Abuse; Sleep
Link ID: 26369 - Posted: 07.01.2019

David Barrie Until the arrival of GPS, the magnetic compass was the single most useful navigational tool available to humans. But it’s a recent invention. Although Chinese explorers understood the principles of the compass earlier, it entered service in Europe in the 12th century. Other animals have been magnetic navigators for much, much longer. Many different species—ranging from newts and insects to sea turtles, fish, and birds—are able to orient themselves relative to the Earth’s magnetic field. Among mammals, naked mole rats, deer, and even dogs also seem to have this gift. Researchers have recently shown that the brainwaves of human beings respond to changes in magnetic fields, though it’s far from clear whether or not we can make any navigational use of this effect. But how all these different species actually detect the Earth’s magnetic field remains largely mysterious. We know that certain bacteria that respond to magnetic fields carry within them crystalline chains of the mineral magnetite, which enables their alignment with the magnetic field in a passive way—just like the needle of a compass. This simple mechanism helps these microbes swim toward the oxygen-deprived depths where many species flourish. Magnetite also seems to be a promising candidate for a “magnetoreceptor” in multicellular organisms. An array of a few million cells containing magnetite could be used to detect small changes in the intensity of the Earth’s magnetic field. Magnetite is found in many organisms, and it is clearly involved in the magnetic sense possessed by some fish. © 1986–2019 The Scientist

Keyword: Animal Migration
Link ID: 26357 - Posted: 06.26.2019

By Carl Zimmer Last week, ladybugs briefly took over the news cycle. Meteorologists at the National Weather Service were looking over radar images in California on the night of June 4 when they spotted what looked like a wide swath of rain. But there were no clouds. The meteorologists contacted an amateur weather-spotter directly under the mysterious disturbance. He wasn’t getting soaked by rain. Instead, he saw ladybugs. Everywhere. Radar apparently had picked up a cloud of migrating ladybugs spread across 80 miles, with a dense core ten miles wide floating 5,000 feet to 9,000 feet in the air. As giant as the swarm was, the meteorologists lost track of it. The ladybugs disappeared into the night. Compared to other animal migrations, the migrations of insects are a scientific mystery. It’s easy to spot a herd of wildebeest making its way across the savanna. Insects, even in huge numbers, move from place to place without much notice. One day you look around, and ladybugs are everywhere. “The migrations themselves are totally invisible,” said Jason Chapman, an ecologist at the University of Exeter in Britain. Dr. Chapman and his colleagues are using radar to bring insect migrations to light. The scientists help run a unique network of small radar stations in southern England designed to scan the sky 24 hours a day, spotting insects flying overhead. “These radars are fantastic,” said Dr. Chapman. “We have a lot of information about every individual insect that flies over overhead, including a measure of the shape and a measure of their size.” © 2019 The New York Times Company

Keyword: Animal Migration
Link ID: 26329 - Posted: 06.14.2019

By Sarah Baird Few topics occupy pregnant women’s minds in the months leading up to birth more than devising a plan for pain management during labor. In the United States, the options during delivery have long been pretty limited. On one side of the dichotomy is a completely unmedicated childbirth, where visualization and breathing techniques offer a mind-over-matter approach to labor pain. On the other side, epidurals are the pain-eliminating gold standard — but can come with plenty of trade-offs. Across the world, though, nitrous oxide (yes, “laughing gas”) has long been standard — dating back to the turn-of-the-century — in delivery rooms, allowing women to help mitigate the pain of labor while remaining present and, perhaps best of all, maintaining their sense of control. Now, this low-stakes form of delivery room relief is finally taking hold in the United States as women seek out a wider range of options for their birthing experience. Nitrous oxide is a blend of 50 percent nitrous and 50 percent oxygen that women are able to self-administer during labor by holding a face mask over their nose and mouth and breathing deeply. (The 50/50 ratio is a set concentration and cannot be raised or lowered, unlike the dialed system in a dentist’s office which can be increased up to 70 percent nitrogen.) The option, unlike other types of pain relief, requires no I.V., does not limit mobility and will not slow contractions. The effects of nitrous kick in within 30 to 50 seconds of beginning inhalation, providing a very different form of pain management than other methods available. “It’s been described as a dissociative effect, so it reduces anxiety related to pain and kind of disassociates [women] from their pain,” said Kelly Curlee, R.N., director of inpatient nursing at Texas Health Cleburne in Cleburne, Tex. “Pain breeds fear, fear breeds pain. That’s kind of a cycle that nitrous helps break.” © 2019 The New York Times Company

Keyword: Pain & Touch
Link ID: 26319 - Posted: 06.10.2019

Patti Neighmond Jeannine, who is 37 and lives in Burbank, Calif., has endured widespread pain since she was 8. She has been examined by dozens of doctors, but none of their X-rays, MRIs or other tests have turned up any evidence of physical injury or damage. Over the years, desperate for relief, she tried changing her diet, wore belts to correct her posture and exercised to strengthen muscles. Taking lots of ibuprofen helped, she says, but doctors warned her that taking too much could cause gastric bleeding. Nothing else eased her discomfort. On a pain scale of 0 to 10, her pain ranged from "7 to 9, regularly," she says. Around 50 million Americans suffer from chronic pain. Most of us think of pain as something that arises after a physical injury, accident or damage from an illness or its treatment. But researchers are learning that, in some people, there can be another source of chronic pain. Repeated exposure to psychological trauma, or deep anxiety or depression — especially in childhood — can leave a physical imprint on the brain that can make some people, like Jeannine, more vulnerable to chronic pain, scientists say. (We are not using her last name for reasons of privacy.) Jeannine was eventually diagnosed with fibromyalgia — a condition characterized by widespread pain throughout the body, among other symptoms. The cause is unknown and likely varies from person to person. The pain Jeannine experienced was physical. She'd feel "lightning bolts, kind of going up through my shoulders to my neck to my head," she says. Other times, she'd suddenly experience the shooting pain of sciatica in her legs, and she often suffered from a "grinding pain" in her hips. "I would feel like I can't walk anymore — it was just so very painful to walk." © 2019 npr

Keyword: Pain & Touch
Link ID: 26316 - Posted: 06.10.2019

By Frances Cronin Health reporter Alison Cameron, from Dorset, was 17 when she had appendicitis and went into hospital. "I had my appendix out and I remember I came round out of the anaesthetic screaming, the pain was something else." It was the start of a "horrendous" three years of investigation before "they came to the conclusion through a process of elimination, it was nerve damage". Over the next 30 years, Alison had more than 50 injections, known as cryoblocks, to freeze the site of her abdominal pain, but none of them stopped the pain for more than six months. This left her needing high doses of painkillers which left her unable to eat or drink - and she ended up on a feeding tube which led to her losing weight, and her health deteriorating. But she says she always tried to stay positive, which was instilled in her by her mum. "No matter how bad things have been, I've always been able to find a positive at the end of the day. That isn't saying that I didn't have some very, very low moments. "I miscarried seven times - six of which were definitely down to the pain. So not only have I paid the price - but also those potential lives." She managed to have two children in the gaps between treatment, and now has three grandchildren. The eldest burst into tears the first time she saw Alison without an eating tube, "as that, for her, wasn't normal granny". Five years ago, a cryoblock caused a collapsed lung, and Alison was referred to consultant neurosurgeon Girish Vajramani at the University Hospital Southampton. "Alison is one of the most challenging patients I have ever known," he says. "She had undergone 50 cryoblocks over 30 years, which is unprecedented, and resulted in her referral to me when this proved too dangerous." © 2019 BBC

Keyword: Pain & Touch
Link ID: 26299 - Posted: 06.05.2019

By Cara Giaimo If you’ve ever taken a big bite of wasabi, you know what comes next: a painful zing that creeps over your whole scalp. You aren’t the only animal that feels this way. The condiment’s sinus-burning kick comes from a chemical compound called allyl isothiocyanate, or AITC, that actively damages proteins within cells. Flies and flatworms shun it, as do mice and wolf spiders. “Practically every animal you look at will avoid AITC,” said Gary Lewin, a molecular physiologist at the Max Delbrück Center for Molecular Medicine in Berlin. But there is one exception. In a paper published Thursday in Science, scientists including Dr. Lewin showed that the highveld mole rat, a rodent found in South Africa, is entirely impervious to the substance. The study “demonstrates the power of studying naturally occurring differences in pain sensitivity,” said Ewan St. John Smith, a neurobiologist at the University of Cambridge, who was not involved in the research. The work could eventually lead to more effective pain treatment in humans. The scientists didn’t originally set out to find a wasabi aficionado. They were simply hoping to compare how several mole rat species respond to things that cause pain. Years ago, Dr. Lewin and others discovered that naked mole rats — pink, bucktoothed creatures known for their uncanny longevity, insectlike social cultures and blasé attitude toward oxygen — aren’t sensitive to acid or capsaicin, the compound that gives peppers their burn. To see whether their close relatives shared these traits, they exposed nine species of mole rat to a few pain agents. The naked mole rats didn’t react well to AITC. Neither did most of the other species the group studied, including the humans administering the trials. © 2019 The New York Times Company

Keyword: Pain & Touch
Link ID: 26282 - Posted: 05.31.2019

By Jan Hoffman Opening statements in the country’s first trial over whether a pharmaceutical company is liable for the opioid crisis began as a battle between fire and ice: Lawyers for Oklahoma, a state brought to its knees by addiction and overdose deaths, heatedly accused Johnson & Johnson of creating a deadly demand for the drugs, while the company coolly responded that it had acted responsibly and lawfully in its quest to offer relief to chronic pain patients. The trial, heard by a judge without a jury but livestreamed to the public, is being closely watched not only by those affected by prescription opioid addiction, but also by lawyers in almost 1,900 similar federal and state cases nationwide. Two other defendants who manufacture opioids settled with Oklahoma — Purdue Pharma will pay $270 million, Teva Pharmaceuticals, $85 million — leaving only J & J on trial. The state directly confronted what many legal experts have predicted will be the highest hurdle in the case: connecting one manufacturer of opioids to the cascading harms wrought by the entire industry. J & J pushed back hard, arguing that the state itself looked the other way as its own drug review board and prescription monitoring program for years neglected to swoop down on sources of diverted opioids. In addition, it said, Oklahoma could not tie any death directly to the company’s products — Duragesic, a fentanyl patch, and Nucynta, an opioid pill it no longer makes. “You hear about pill mills,” said Larry D. Ottaway, the lead counsel for a J & J subsidiary, Janssen Pharmaceuticals. “You don’t hear about patch mills.” Indeed both sides introduced what are sure to be their signature earworms, themes that will be echoed throughout the trial, estimated to take about two months. © 2019 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 26275 - Posted: 05.29.2019

By Jane E. Brody One of the most widely prescribed prescription drugs, gabapentin, is being taken by millions of patients despite little or no evidence that it can relieve their pain. In 2006, I wrote about gabapentin after discovering accidentally that it could counter hot flashes. The drug was initially approved 25 years ago to treat seizure disorders, but it is now commonly prescribed off-label to treat all kinds of pain, acute and chronic, in addition to hot flashes, chronic cough and a host of other medical problems. The F.D.A. approves a drug for specific uses and doses if the company demonstrates it is safe and effective for its intended uses, and its benefits outweigh any potential risks. Off-label means that a medical provider can legally prescribe any drug that has been approved by the Food and Drug Administration for any condition, not just the ones for which it was approved. This can leave patients at the mercy of what their doctors think is helpful. Thus, it can become a patient’s job to try to determine whether a medication prescribed off-label is both safe and effective for their particular condition. This is no easy task even for well-educated doctors, let alone for desperate patients in pain. Two doctors recently reviewed published evidence for the benefits and risks of off-label use of gabapentin (originally sold under the trade name Neurontin) and its brand-name cousin Lyrica (pregabalin) for treating all kinds of pain. (There is now also a third drug, gabapentin encarbil, sold as Horizant, approved only for restless leg syndrome and postherpetic neuralgia, which can follow a shingles outbreak.) © 2019 The New York Times Company

Keyword: Pain & Touch; Drug Abuse
Link ID: 26253 - Posted: 05.21.2019

Jon Hamilton When Sterling Witt was a teenager in Missouri, he was diagnosed with scoliosis. Before long, the curvature of his spine started causing chronic pain. It was "this low-grade kind of menacing pain that ran through my spine and mostly my lower back and my upper right shoulder blade and then even into my neck a little bit," Witt says. The pain was bad. But the feeling of helplessness it produced in him was even worse. "I felt like I was being attacked by this invisible enemy," Witt says. "It was nothing that I asked for, and I didn't even know how to battle it." So he channeled his frustration into music and art that depicted his pain. It was "a way I could express myself," he says. "It was liberating." Witt's experience is typical of how an unpleasant sensation can become something much more complicated, scientists say. "At its core, pain is just something that hurts or makes you say ouch," says Karen Davis, a senior scientist at the Krembil Brain Institute in Toronto. "Everything else is the outcome of the pain, how it then impacts your emotions, your feelings, your behaviors." The ouch part of pain begins when something — heat, certain chemicals or a mechanical force — activates special nerve endings called nociceptors. © 2019 npr

Keyword: Pain & Touch
Link ID: 26249 - Posted: 05.20.2019

By Gabrielle Emanuel and Katie Thomas BOSTON — A federal jury on Thursday found the top executives of Insys Therapeutics, a company that sold a fentanyl-based painkiller, guilty of racketeering charges in a rare criminal prosecution that blamed corporate officials for contributing to the nation’s opioid epidemic. The jury, after deliberating for 15 days, issued guilty verdicts against the company’s founder, the onetime billionaire John Kapoor, and four former executives, finding they had conspired to fuel sales of its highly potent drug, Subsys, by not only bribing doctors to prescribe their product but also by misleading insurers about patients’ need for the drug. The verdict against Insys executives is a sign of the accelerating effort to hold pharmaceutical and drug distribution companies and their executives and owners accountable in ways commensurate with the devastation wrought by the prescription opioid crisis. More than 200,000 people have overdosed on such drugs in the past two decades. Federal authorities last month for the first time filed felony drug trafficking charges against a major pharmaceutical distributor, Rochester Drug Cooperative, and two former executives, accusing them of shipping tens of millions of oxycodone pills and fentanyl products to pharmacies that were distributing drugs illegally. And the state attorneys general of Massachusetts and New York have recently sued not just Purdue Pharma, the maker of OxyContin, but also members of the Sackler family who own the company — and who have largely escaped personal legal penalties for the company’s role in the epidemic, culpability they deny. © 2019 The New York Times Company

Keyword: Drug Abuse; Pain & Touch
Link ID: 26209 - Posted: 05.04.2019

By Jane E. Brody I was packing up at the end of a family vacation in Florida when my back went into an excruciating spasm unrelieved by a fistful of pain medication. As my twin sons, then 8 years old, wheeled me through the airport, one of them suggested, “Mom, if you think about something else, it won’t hurt so much.” At the time, I failed to appreciate the wisdom of his advice. Now, four decades later, a sophisticated distraction technique is being used to help patients of all ages cope with pain, both acute and chronic. The method, called Virtual Reality Therapy, goes beyond simple distraction, as might result from watching television. Rather, it totally immerses the patient in an entertaining, relaxing, interactive environment that so occupies the brain, it has no room to process pain sensations at the same time. “It’s not just a distraction — it’s like an endogenous narcotic providing a physiological and chemical burst that causes you to feel good,” said Jeffrey I. Gold, director of the pediatric pain management clinic at Children’s Hospital Los Angeles. “It’s different from reading a book or playing with a toy. It’s a multisensory experience that engages a person’s attention on a much deeper level.” Virtual Reality Therapy is the new kid on the block for pain management, now gradually growing in use as the opioid epidemic continues to soar and the price of the needed equipment has plummeted. VR, as it is called, has been most widely and successfully used so far to help children and adults weather acute pain, as can accompany an IV insertion or debridement of burns. But it can also enhance the effectiveness of established techniques like physical therapy, hypnosis and cognitive behavioral therapy to treat debilitating chronic pain. © 2019 The New York Times Company

Keyword: Pain & Touch; Attention
Link ID: 26182 - Posted: 04.29.2019