Pain
Chronic Pain Found to Increase Risk of Falls in Older Adults
|
|
Chronic pain is experienced by as many as two out of three older adults. Now, a new study finds that pain may be more hazardous than previously thought, contributing to an increased risk of falls in adults over age 70. The findings appear in the November 25 issue of The Journal of the American Medical Association (JAMA).
“It’s clear that pain is not just a normal part of aging and that pain is often undertreated in older adults,” explains lead author Suzanne Leveille, PhD, RN, who conducted the research while a member of the Division of Primary Care at Beth Israel Deaconess Medical Center (BIDMC) and is currently on the faculty at the University of Massachusetts Boston. “Our findings showed that older adults who reported chronic musculoskeletal pain in two or more locations – mainly in the joints of the arms and legs – as well as individuals who reported more severe pain or pain that interfered with daily activities were more likely to experience a fall than other individuals.”
Research shows Tai Chi exercise reduces knee osteoarthritis pain in the elderly
|
|
Researchers from Tufts University School of Medicine have determined that patients over 65 years of age with knee osteoarthritis (OA) who engage in regular Tai Chi exercise improve physical function and experience less pain. Tai Chi (Chuan) is a traditional style of Chinese martial arts that features slow, rhythmic movements to induce mental relaxation and enhance balance, strength, flexibility, and self-efficacy. Full findings of the study are published in the November issue of Arthritis Care & Research, a journal of the American College of Rheumatology.
The elderly population is at most risk for developing knee OA, which results in pain, functional limitations or disabilities and a reduced quality of life. According to the Centers for Disease Control and Prevention (CDC) there are 4.3 million U.S. adults over age 60 diagnosed with knee OA, a common form of arthritis that causes wearing of joint cartilage. A recent CDC report further explains that half of American adults may develop symptoms of OA in at least one knee by age 85.
For this study, Chenchen Wang, M.D., M.Sc., and colleagues recruited 40 patients from the greater Boston area with confirmed knee OA who were in otherwise good health. The mean age of participants was 65 years with a mean body mass index of 30.0 kg/m2. Patients were randomly selected and 20 were asked to participate in 60-minute Yang style Tai Chi sessions twice weekly for 12 weeks. Each session included: a 10-minute self-massage and a review of Tai Chi principles; 30 minutes of Tai Chi movement; 10 minutes of breathing technique; and 10 minutes of relaxation.
Antidepressant and placebo are equally effective in child pain relief
|
|
When used “off-label,” the antidepressant amitriptyline works just as well as placebo in treating pain-predominant gastrointestinal disorders in children, according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association (AGA) Institute. To view this article’s video abstract, go to the AGA’s YouTube Channel at http://www.youtube.com/AmerGastroAssn.
“Many pharmaceutical products are prescribed for off-label use in children due to the lack of clinical trials testing the efficacy of the drugs in children and adolescents. Therefore, the pediatric gastroenterologist frequently has to make treatment decisions without the evidence of how drugs work in children,” said Miguel Saps, MD, of Children’s Memorial Hospital and lead author of the study. “The high placebo effect we identified in this study suggests that further studies of the use of certain antidepressants in children with functional bowel disorders are needed. While several trials have demonstrated a beneficial effect of antidepressants, including amitriptyline, for the treatment of irritable bowel syndrome (IBS) in adults, more research is needed to determine how effective this drug is, if at all, in children.”
Amitriptyline (Elavil®) is used to treat symptoms of depression, however, it is often times prescribed to children for pain relief from pain-predominant functional gastrointestinal disorders (FGIDs). Pain-predominant FGIDs are among the most common causes for medical consultation in children. Such disorders include three common conditions: IBS, functional dyspepsia and functional abdominal pain.
A relief? Lower back pain unlikely to mean cancer
|
|
Your lower back pain may be killing you, but there’s some good news: Such pain is very unlikely to mean serious problems such as broken vertebrae or cancer, according to a study by Australian researchers.
Dr. Christopher G. Maher, from The George Institute of International Health in Sydney, and colleagues studied 1172 patients who came to general practitioners, physical therapists, or chiropractors with a new complaint of lower back pain.
The patients were monitored for 12 months to look for broken bones, infection, arthritis, or cancer was the cause.
Study Assesses Alcohol Use by Pain Patients
|
|
Clinicians treating patients with chronic pain must assess their alcohol use and, if necessary, provide counseling regarding problems associated with mixing alcohol and pain medications, according to a study published in The Journal of Pain, the peer review publication of the American Pain Society.
Researchers from the University of Florida College of Dentistry examined use of alcohol to relieve pain in more than 4,000 adults with tooth pain, jaw or face pain and arthritis. Previous studies have shown that adverse reactions occur when alcohol is mixed with prescription pain medications, especially gastrointestinal disorders and liver problems. Also, studies show alcohol is used often to manage stress, and chronic pain is considered a significant stressor.
The purpose of the study was to document the prevalence of alcohol use for managing pain among community dwelling adults, learn demographic differences in the use of alcohol for pain, and evaluate if the impact of pain and social and economic factors is associated with using alcohol for pain. Study subjects were interviewed by telephone.
Computer system improves pain therapy for cancer patients
|
|
Successful test of electronic decision support on applying international therapy guidelines / Clinical pharmacologists from Heidelberg publish results in “Pain”
Pain therapy for cancer patients – whether inpatient or outpatient – is often inadequate. At Heidelberg University Hospital, the use of an innovative electronic system – combined with guidance by an experienced clinical pharmacist – has been successfully tested. The treatment of the patients showed little variance from international guidelines on pain therapy. In addition, patients reported having less pain. The results of the study have been published in the journal Pain.
The electronic pain relief guide AiDPainCare is an additional instrument of the electronic pharmaceutical guide AiDKlinik, which guides physicians safely through the current pharmaceutical market in Germany with over 64,000 products and successfully helps avoid false dosages, side effects, dangerous drug interaction, and duplications in prescriptions. The medication prescribed by the physician can be transferred from AiDKlinik directly to a prescription or medical report. The system is currently in use in 10 hospitals in Germany and can also be subscribed to by physicians in private practice (http://www.doctors-aid.de).
Age not linked to Achilles pain in older athletes
|
|
Age does not seem to play a role in the development of Achilles tendon problems among older athletes, nor do training and participation in walking, jumping, sprinting, running, or hurdling competitions, findings from a European study suggest.
Achilles tendon pain results from swelling or tiny tears in the tendon that connects the calf muscle to the heel bone. The exact cause of this “overuse” injury, characterized by swelling or mild to severe pain when rising onto the toes or pushing off when walking, is unknown.
The current study, reported in The American Journal of Sports Medicine, involved 110 men and 68 women who were highly trained, competitive track and field athletes participating in the European Veterans Athletics Championships held in Poland in July 2006.
Cupping Therapy Alleviates Carpal Tunnel Syndrome Pain
|
|
A German study published in The Journal of Pain showed that an external suction technique mainly used outside the U.S., called cupping, is effective for providing temporary relief of pain from carpal tunnel syndrome (CPS).
Researchers from Immanuel Hospital Berlin randomly divided fifty-two CPS patients into treatment and control groups. The treatment group was given wet cupping therapy in which cupping glasses are applied to skin overlaying the trapezius muscle following 5 to 10 skin punctures with a sterile lancet. A partial vacuum is created by electromechanical or manual suction within the cupping glass after it is applied to the skin.
The technique is used as a healing method in China, India, Arabia, Central Europe and parts of Africa. Cupping is applied to defined zones of the shoulder triangle which are connective tissue zones at the shoulder-neck region. The technique is believed to increase microcirculation to help relieve CPS symptoms.
Fibromyalgia Patients Show Decreases in Gray Matter Intensity
|
|
Previous studies have shown that fibromyalgia is associated with reductions in gray matter in parts of the brain, but the exact cause is not known. Using sophisticated brain imaging techniques, researchers from Louisiana State University, writing in The Journal of Pain, found that alterations in levels of the neurotransmitter dopamine might be responsible for gray matter reductions.
For the study, magnetic imaging resonance data from 30 female fibromyalgia patients were compared with 20 healthy women of the same age. The primary objective of the study was to confirm original findings about reduced gray matter density in a larger sample of fibromyalgia patients. They explored whether there is a correlation between dopamine metabolic activity and variations in the density of gray matter in specific brain regions.
Intervention Helps Reduce Pain and Depression
|
|
For patients who experience pain and depression, common co-existing conditions, an intervention that included individually tailored antidepressant therapy and a pain self-management program resulted in greater improvement in the symptoms of these conditions than patients who received usual care, according to a study in the May 27 issue of JAMA.
Pain complaints account for more than 40 percent of all symptom-related outpatient visits, and depression is present in 10 percent to 15 percent of all patients who receive primary care. Pain and depression frequently co-exist (30 percent-50 percent co-occurrence), effect the treatment responsiveness of each, and have adverse effects on quality of life, disability, and health care costs, according to background information in the article.
Kurt Kroenke, M.D., of Indiana University School of Medicine and the Regenstrief Institute, Indianapolis, and colleagues conducted a study to determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and co-existing depression. The trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) included 250 patients who had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity. Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). Depression was assessed with the 20-item Hopkins Symptom Checklist, and pain primarily with the Brief Pain Inventory.
1 gene regulates pain, learning and memory
|
|
In 2002, a group of scientists at the University of Toronto was able to identify a gene which they dubbed DREAM (downstream regulatory element antagonistic modulator). The gene’s function was highly interesting: it obviously served as a key regulator in the perception of pain. Mice who lacked the gene showed clear signs of markedly reduced sensitivity to all kinds of pain, whether chronic or acute. Otherwise, the mice appeared perfectly normal.
The work leading to these findings was carried out in the lab of Josef Penninger, then principal investigator at the Amgen Institute in Toronto. The publication describing the gene’s function was received with great interest (Cell, Vol. 108, 31-43, 11.1.2002) and DREAM was subsequently termed the “Master-Gene of pain perception”.
Josef Penninger, meanwhile scientific director of IMBA, the Institute of Molecular Biotechnology of the Austrian Academy of Sciences in Vienna, continued to wonder what other surprises DREAM might have in store. In a collaborative effort with neurobiologists from the University Pablo de Olivade (Seville) he devised experiments to follow up on the previous findings. A team of scientists under Ángel Manuel Carrión subjected DREAM-less mice to numerous neurological tests and analyzed their memory skills. The results were striking: without DREAM, mice were able to learn faster and remember better. Fascinatingly, the brains of aged mice (18 months) showed learning capacities similar to those of very young mice.
Obese elderly at high risk for chronic pain
|
|
Half of people aged 70 and older suffer from some type of chronic pain, and women and the obese are particularly vulnerable, new research shows.
Chronic pain, defined as pain that persists for three months or longer, is known to be common among older people, Dr. Richard B. Lipton and colleagues from the Albert Einstein College of Medicine in the Bronx, New York, note. Obesity is becoming increasingly prevalent among US seniors, they add, so studying the relationship between excess weight and chronic pain among older people—as well as the role of conditions that might influence both pain and obesity, such as mental health problems, should be studied.
To that end, Lipton and his team looked at 840 men and women participating in the Einstein Aging Study, an ongoing investigation of people 70 and older living in the Bronx.
New study proves that pain is not a symptom of arthritis, pain causes arthritis
|
|
Pain is more than a symptom of osteoarthritis, it is an inherent and damaging part of the disease itself, according to a study published today in journal Arthritis and Rheumatism. More specifically, the study revealed that pain signals originating in arthritic joints, and the biochemical processing of those signals as they reach the spinal cord, worsen and expand arthritis. In addition, researchers found that nerve pathways carrying pain signals transfer inflammation from arthritic joints to the spine and back again, causing disease at both ends.
Technically, pain is a patient’s conscious realization of discomfort. Before that can happen, however, information must be carried along nerve cell pathways from say an injured knee to the pain processing centers in dorsal horns of the spinal cord, a process called nociception. The current study provides strong evidence that two-way, nociceptive “crosstalk” may first enable joint arthritis to transmit inflammation into the spinal cord and brain, and then to spread through the central nervous system (CNS) from one joint to another.
Furthermore, if joint arthritis can cause neuro-inflammation, it could have a role in conditions like Alzheimer’s disease, dementia and multiple sclerosis. Armed with the results, researchers have identified likely drug targets that could interfere with key inflammatory receptors on sensory nerve cells as a new way to treat osteoarthritis (OA), which destroys joint cartilage in 21 million Americans. The most common form of arthritis, OA eventually brings deformity and severe pain as patients loose the protective cushion between bones in weight-bearing joints like knees and hips.
Sex bias seen in control of cancer pain
|
|
How well pain is managed in people with cancer apparently differs between men and women, new research hints.
Dr. Kristine A. Donovan, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues examined pain severity and the adequacy of pain management in 131 cancer patients newly referred to a multidisciplinary cancer pain clinic.
Men and women did not differ significantly in terms of worst pain scores, least pain scores, or pain interference. However, average pain in the last week and pain right now were significantly higher in women.
Pain appears common among patients with Parkinson’s disease
|
|
Pain appears to be more common in individuals with Parkinson’s disease than in those without, suggesting that pain is associated with the condition, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.
“Patients with Parkinson’s disease often complain of painful sensations that may involve body parts affected and unaffected by dystonia,” or involuntary muscle contractions, the authors write as background information in the article. This pain may resemble cramping or arthritis, or have features of pain caused by nerve damage. “The high frequency of these pain disorders in the general population makes it hard to establish whether pain is more frequent among people with Parkinson’s disease than among age-matched controls.”
Giovanni Defazio, M.D., Ph.D., of the University of Bari, Italy, and colleagues compared 402 patients with Parkinson’s disease to 317 healthy individuals who were the same age. Participants provided information about their current age, the age at which they developed Parkinson’s disease, scores on disease rating scales and details regarding any pain that was present at the time of the study and lasted for at least three months.
