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How Evolution Made the Highveld Mole Rat Impervious to Ant Stings

Shawna Williams Pain, unpleasant though it may be, is essential to most mammals’ survival, a warning to back off before we lose a limb or worsen a wound. So it was curious when, in a 2008 study, molecular physiologist Gary Lewin and his colleagues found that, unlike most mammals, naked mole rats (Heterocephalus glaber) didn’t lick or flick a limb that had been injected with a small amount of capsaicin—the hot in hot chili pepper. The mole rats turned out to be similarly nonchalant when exposed to dilute hydrochloric acid. “We wondered, first of all, how they became insensitive to these things,” says Lewin, who heads up a lab at Berlin’s Max Delbrück Center for Molecular Medicine. The team took an evolutionary approach to finding the answer. Several group members traveled to the naked mole rat’s native territory of East Africa to try out three common pain-causing substances on seven other mole rat species, plus the more distantly related East African root rat. They found that, in addition to the naked mole rat, the Natal mole rat was insensitive to capsaicin, while the Cape mole rat and the root rat didn’t seem to feel a burn from the hydrochloric acid. Most startlingly, one species, the highveld mole rat (Cryptomys hottentotus pretoriae), didn’t flinch when injected with a few milliliters of a highly diluted solution of an irritant present in mustard and wasabi known as AITC—an agent that even the naked mole rat reacted to. When team member Karlien Debus donned a gas mask to inject a similar amount of 100 percent AITC under the skin of a highveld mole rat, there was still no response. “Probably the AITC was the most interesting because AITC is a substance that actually every [other] animal in the entire animal kingdom avoids,” Lewin says. An electrophilic compound, AITC can crosslink an animal’s proteins and damage its cells. © 1986–2019 The Scientist.

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 6: Evolution of the Brain and Behavior
Related chapters from MM:Chapter 5: The Sensorimotor System
Link ID: 26623 - Posted: 09.19.2019

Artists who paint with their feet have ‘toe maps’ in their brains

By Laura Sanders Two artists who paint with their toes have unusual neural footprints in their brains. Individual toes each take over discrete territory, creating a well-organized “toe map,” researchers report September 10 in Cell Reports. Similar brain organization isn’t thought to exist in people with typical toe dexterity. So finding these specialized maps brings scientists closer to understanding how the human brain senses the body, even when body designs differ (SN: 6/12/19). “Sometimes, having the unusual case — even the very rare one — might give you important insight into how things work,” says neuroscientist Denis Schluppeck of the University of Nottingham in England, who was not involved in the study. The skills of the two artists included in the study are certainly rare. Both were born without arms due to the drug thalidomide, formerly used to treat morning sickness in pregnant women. As a result, both men rely heavily on their feet, which possess the dexterity to eat with cutlery, write and use computers. The brain carries a map of areas that handle sensations from different body parts; sensitive fingers and lips, for example, have big corresponding areas. But so far, scientists haven’t had much luck in pinpointing areas of the human brain that respond to individual toes (although toe regions have been found in the brains of nonhuman primates). But because these men use their feet in unusually skilled ways, researchers wondered if their brains might represent toes a bit differently. The two artists, along with nine other people with no special foot abilities, underwent functional MRI scans while an experimenter gently touched each toe. For many people, the brain areas that correspond to individual toes aren’t discrete, says neuroscientist Daan Wesselink of University College London. But in the foot artists’ brains, “we found very distinct locations for each of their toes.” When each toe was touched, a patch of brain became active, linking neighboring toes to similarly neighboring areas of the brain. © Society for Science & the Public 2000–2019

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 2: Functional Neuroanatomy: The Cells and Structure of the Nervous System
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 1: Cells and Structures: The Anatomy of the Nervous System
Link ID: 26601 - Posted: 09.11.2019

Women May Be More Adept Than Men At Discerning Pain

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

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 8: Hormones and Sex
Link ID: 26546 - Posted: 08.27.2019

The Problem With MRIs for Low Back Pain

/ 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

Poll: Nearly 1 in 5 Americans Says Pain Often Interferes With Daily Life

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

Scientists discover new pain-sensing organ

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

‘My entire scalp was on fire’: A doctor repeatedly insisted she had a tension headache

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

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 5: The Sensorimotor System
Link ID: 26485 - Posted: 08.12.2019

'At last I can feel again': robotic hand gives user a sense of touch

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

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 5: The Sensorimotor System
Link ID: 26449 - Posted: 07.25.2019

Skin sensors are the future of health care

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.

In Hawaii, Rat Lungworm Disease Infects People but Eludes Researchers

By Knvul Sheikh A tropical parasite transmitted through rats and snails has caught the attention of health officials in Hawaii. But few scientists have studied the infection once it makes its way into humans, and researchers can’t say for certain whether the disease is becoming more widespread. The parasite, Angiostrongylus cantonensis, typically resides in a rat’s pulmonary arteries and is commonly known as “rat lungworm.” When its eggs hatch, tiny larvae are shed in the animals’ feces and eaten by snails or slugs. Those slugs, in turn, are often mistakenly eaten by people, on unwashed produce or in drinks that have been left uncovered. Although the larvae can’t grow into adult worms in a human host, they still can cause various complications, including flulike symptoms, headaches, stiff necks and bursts of nerve pain that seem to shift from one part of the body to another. M.R.I. scans suggest that the worms can also wriggle into the brain, leading to eosinophilic meningitis, which in rare cases can cause paralysis. Doctors in the state have noted cases of rat lungworm disease since at least 1959. But it is difficult to diagnose. To better track it, and to identify areas that prevention efforts should target, the Hawaii Department of Health began monitoring rat lungworm infections about a decade ago. From 2007 to 2017, officials tallied 82 cases, two of which resulted in death. Another 10 cases were reported in 2018, and six more have been reported among visitors and residents already this year. From the team at NYT Parenting: Get the latest news and guidance for parents. We'll celebrate the little parenting moments that mean a lot — and share stories that matter to families. The east side of the Big Island, in particular, has become a hot spot for infections, according to a review of cases published Monday in the American Journal of Tropical Medicine and Hygiene. Researchers are not sure why. Rats may be more numerous there, or more heavily infected, or more likely to cross paths with humans and infect them. Increased awareness about the disease may also have led to more infections being recognized than in the past. © 2019 The New York Times Company

Related chapters from BN: Chapter 1: Introduction: Scope and Outlook; Chapter 11: Motor Control and Plasticity
Related chapters from MM:Chapter 20: ; Chapter 5: The Sensorimotor System
Link ID: 26416 - Posted: 07.13.2019

The Rise of Laughing Gas in the Delivery Room

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

Can You Reshape Your Brain's Response To Pain?

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

'Life is wonderful' being pain-free after 40 years

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

These Mole Rats Felt No Pain, Even From Wasabi’s Burn

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

Millions Take Gabapentin for Pain. But There’s Scant Evidence It Works

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

How The Brain Shapes Pain And Links Ouch With Emotion

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

Virtual Reality as Therapy for Pain

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

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 18: Attention and Higher Cognition
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 14: Attention and Higher Cognition
Link ID: 26182 - Posted: 04.29.2019

Feds issue new warning to doctors: Don't skimp too much on opioid pain pills

Jayne O'Donnell and Ken Alltucker, Doctors are misusing 2016 opioid pain medication guidelines, federal officials said Wednesday, a clear response to increasing complaints from chronic pain patients who say they are the victims of an overreaction to the opioid crisis. The Centers for Disease Control and Prevention, in new guidance for opioid prescribing, said many physicians were guilty of a "misapplication" of 2016 guidelines that clamped down on the use of opioids. The new guidelines, published in the New England Journal of Medicine, was the latest federal acknowledgement that many physicians' responses to the opioid crisis went too far. Former Food and Drug Administration commissioner Scott Gottlieb, a physician, spoke out last July about the impact the opioid crisis response had on pain patients when he called for development of more options. Until then, people in the middle of cancer treatments, having "acute sickle cell crises" or with pain after surgery shouldn't be affected by the earlier recommendations, CDC said. These patients were outside the scope of the guidelines, which were intended for primary care doctors treating chronic pain patients, CDC said. Doctors that set hard limits or cut off opioids are also misapplying the government's guidance, CDC said. Doctors should prescribe the lowest effective dosage and avoid increasing it to 90 "morphine milligram equivalents" a day or "carefully justify" any decision to raise the dose to that level.

How A.S.M.R. Became a Sensation

By Jamie Lauren Keiles When Jennifer Allen watched videos of space, she sometimes felt this peculiar sensation: a tingling that spread through her scalp as the camera pulled back to show the marble of the earth. It came in a wave, like a warm effervescence, making its way down the length of her spine and leaving behind a sense of gratitude and wholeness. Allen loved this feeling, but she didn’t know what caused it. It was totally distinct from anything she’d experienced before. Every two years or so she’d take to Google. She tried searching things like “tingling head and spine” or “brain orgasm.” For nine years, the search didn’t turn up anything. Then, around 2009, it did. As always, Allen typed her phrases into Google, but this time she got a result on a message board called SteadyHealth. The post was titled WEIRD SENSATION FEELS GOOD: i get this sensation sometimes. theres no real trigger for it. it just happens randomly. its been happening since i was a kid and i’m 21 now. some examples of what it seems has caused it to happen before are as a child while watching a puppet show and when i was being read a story to. as a teenager when a classmate did me a favor and when a friend drew on the palm of my hand with markers. sometimes it happens for no reason at all The poster went on to demand an explanation. In the discussion, nobody had one, but many described a similar feeling — a “silvery sparkle” inside the head, a euphoric “brain-gasm” or a feeling like goose bumps in the scalp that faded “in and out in waves of heightened intensity.” Many people agreed that the sensation was euphoric. (“Aside from an actual orgasm, it’s probably the most enjoyable sensation possible,” one user wrote.) Its triggers were as varied as watching someone fill out a form, listening to whispering sounds or seeing Bob Ross paint landscapes on TV. Allen scrolled through pages and pages of discussion. Oh my gosh, she remembers thinking. These people are talking about exactly what I experience. © 2019 The New York Times Company

Related chapters from BN: Chapter 9: Hearing, Balance, Taste, and Smell; Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 6: Hearing, Balance, Taste, and Smell; Chapter 5: The Sensorimotor System
Link ID: 26114 - Posted: 04.04.2019

How Pain Tolerance and Anxiety Seem to Be Connected

By Heather Murphy An article this week about Jo Cameron, who has lived for 71 years without experiencing pain or anxiety because she has a rare genetic mutation, prompted questions from New York Times readers. The notion that the same gene could be responsible for the way a person processes physical and psychological pain left many perplexed: Aren’t they totally different? Or does her story hint that sensitivity to one type of pain might be intertwined with sensitivity to another? Childbirth, Ms. Cameron said, felt like “a tickle.” She often relies on her husband to alert her when she is bleeding, bruised or burned because nothing hurts. When someone close to her has died, she said, she has felt sad but “I don’t go to pieces.” She cannot recall ever having been riled by anything — even a recent car crash. On an anxiety disorder questionnaire, she scored zero out of 21. “I drive people mad by being cheerful,” she said. Here’s a bit about what’s known: Do those who live without pain also live without anxiety? No. Before encountering Ms. Cameron, the scientists who studied her case worked with other patients who did not experience pain. “Reduced anxiety has not really been noted before in the other pain insensitivity disorders we work on,” said Dr. James Cox, a senior lecturer from the Molecular Nociception Group at University College London. He also said that given Ms. Cameron had gone more than six decades without realizing just how unusual she was, there could be others like her. A number of such individuals contacted The Times after the article was published. © 2019 The New York Times Company

Related chapters from BN: Chapter 8: General Principles of Sensory Processing, Touch, and Pain; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 5: The Sensorimotor System; Chapter 11: Emotions, Aggression, and Stress
Link ID: 26100 - Posted: 04.01.2019

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