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Tag: Pain

  • Scientists Publish New Findings in Quest to Build a Better Opioid

    Scientists Publish New Findings in Quest to Build a Better Opioid

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    Newswise — CHAPEL HILL, NC – In the continuing effort to improve upon opioid pain relievers, American and Chinese scientists used cryoEM technology to solve the detailed structures of the entire family of opioid receptors bound to their naturally occurring peptides. Subsequent structure-guided biochemical studies were then performed to better understand the mechanisms of peptide-receptor selectivity and signaling drugs.

    This work, published in Cell, provides a comprehensive structural framework that should help drug developers rationally design safer drugs to relieve severe pain.

    This work was spearheaded by the lab of Eric Xu, PhD, at the CAS Key Lab of Receptor Research in China, in collaboration with the lab of Bryan L. Roth, MD, PhD, at the UNC School of Medicine, where graduate student Jeff DiBerto led the pharmacological experiments to understand the receptors’ signaling mechanisms.

    Opioid drugs relieve pain by mimicking a naturally occurring pain-relief function within our nervous symptoms. They are the best, strongest pain relievers we have. Unfortunately, they come with side effects, some severe such as numbness, addiction, and respiratory depression, leading to overdose deaths.

    Scientists have been trying for many years to overcome the side-effect problem in various ways, all involving one or more of four opioid receptors to no avail. One way scientists continue to explore is the creation of peptide or peptide-inspired small molecule drugs.

    Peptides are short chains of amino acids; think of them as short proteins. Certain naturally occurring, or endogenous, peptides bind to opioid receptors on the surface of cells to create an analgesic effect, also known as pain relief. Think of an analgesic like an anesthetic, except that analgesics do not “turn off” the nerves to numb the body or alter consciousness. So, the idea is to create a peptide drug that has a strong analgesic effect, without numbing nerves or altering consciousness or causing digestive, respiratory, or addiction issues.

    “The problem in the field is we’ve lacked the molecular understanding of the interplay between opioid peptides and their receptors,” said Roth, co-senior author and the Michael Hooker Distinguished Professor of Pharmacology. “We’ve needed this understanding in order to try to rationally design potent and safe peptide or peptide-inspired drugs.”

    Using cryogenic electron microscopy, or cryoEM, and a battery of biomechanistic experiments in cells, the Xu and Roth labs systematically solved the detailed structures of endogenous peptides bound to all four opioid receptors. These structures revealed details and insights into how specific naturally occurring opioid peptides selectively recognize and activate opioid receptors. The researchers also used exogenous peptides, or drug-like compounds, in some of their experiments to learn how they activate the receptors.

    The cryoEM structures of agonist-bound receptors in complex with their G protein effectors (called their “active state”) represents what these receptors look like when they are signaling in cells, giving a detailed view of peptide-receptor interactions. The Roth lab used the structures solved by the Xu lab to guide the design of mutant receptors, and then tested these receptors in biochemical assays in cells to determine how they alter receptor signaling. Understanding these interactions can then be used to design drugs that are selective for opioid receptor subtypes, as well as to produce certain signaling outcomes that may be more beneficial than those of conventional opioids.

    “This collaboration revealed conserved, or shared, mechanisms of activation and recognition of all four opioid receptors, as well as differences in peptide recognition that can be exploited for creating subtype-selective drugs,” said DiBerto, first author and PhD candidate in the Roth lab. “We provide more needed information to keep pushing the field forward, to answer basic science questions we hadn’t been able to answer before now.”

    Previous research showed the structure of opioid receptors in their inactive or active-like states, with active state structures only existing for the mu-opioid receptor subtype, the primary target of drugs like fentanyl and morphine. In the Cell paper, the authors show agonist-bound receptors in in complex with their G protein effectors, made possible through cryoEM technology that did not exist when currently used medications were being developed.

    Drugs such as oxycontin, oxycodone, and morphine cause various effects inside cells and throughout the nervous symptom, including pain relief. But they have effects in the digestive and respiratory systems, too, and interact with cells to lead to addiction. Fentanyl, meanwhile, is another powerful pain reliever, but it binds to opioid receptors in such a way as to cause severe side effects, including the shutdown of the respiratory system.

    The thrust behind such research led by Xu and Roth is to home in on the mechanistic reasons for pain relief potency without triggering the cellular mechanisms that lead to severe side effects and overdosing.

    “We are attempting to build a better kind of opioid,” Roth says, “We’re never going to get there without these kind of basic molecular insights, wherein we can see why pain is relieved and why side effects occur.”

    Co-first authors of the Cell paper are Yue Wang and Youwen Zhuang of the CAS Key Laboratory of Receptor Research and the State Key Laboratory of Drug Research at the Shanghai Institute of Materia Medica in the Chinese Academy of Sciences. Other authors are Edward Zhou and Karsten Melcher of the Van Andel Research Institute in Grand Rapids, MI, Gavin Schmitz and Manish Jain at the UNC School of Medicine, and Qingning Yuan, Weiyi Liu, and Yi Jiant at the CAS Key Laboratory.

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    University of North Carolina School of Medicine

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  • CeCe Migraine Management App Syncs With CEFALY Connected Device to Provide Personalized Migraine Insights

    CeCe Migraine Management App Syncs With CEFALY Connected Device to Provide Personalized Migraine Insights

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    Newswise — DARIEN, Conn.Jan. 18, 2023 /PRNewswire/ — The award-winning CeCe Migraine Management app now offers users an unprecedented level of insight into their migraine treatments with the CEFALY Connected device.

    The latest version of the CeCe app pairs with the Bluetooth-enabled CEFALY Connected so users can track CEFALY treatments and log migraine attacks on their mobile device. These insights enable them to understand their unique migraine patterns and optimize their treatments.

    CEFALY is a wearable, external trigeminal nerve stimulation (eTNS) device that relieves migraine pain and prevents attacks by stimulating and desensitizing the trigeminal nerve. When a user pairs their CEFALY Connected device with the CeCe app, they can:

    • Monitor their CEFALY sessions in real time so they can adjust the intensity for optimal results
    • See session time remaining and battery life at a glance
    • Log CEFALY sessions and migraine attacks to track treatment effectiveness over time
    • Download a PDF report with their unique migraine patterns and treatment data to share with healthcare providers.

    The free CeCe app, first introduced in 2021, can also be used on its own to log migraine attacks, triggers, symptoms, and treatments. CeCe received the 2021 Distinction Award for Best Native Mobile App in the eHealthcare Leadership Awards.

    “We designed CeCe to serve everyone in the migraine community, whether or not they use CEFALY,” said Jen Trainor McDermott, CEO of CEFALY Technology. “When used in conjunction with the CEFALY Connected, however, the CeCe app gives users the ability to truly understand their migraine treatment journey. Being able to monitor and track CEFALY sessions in real time helps people commit to their treatment routine and see the progress they’re making.”

    At least 39 million Americans live with migraine, which is a complex, debilitating and often misunderstood neurological disorder. CEFALY, which was first introduced in 2008, is the only FDA-cleared migraine treatment device used for the treatment and prevention of migraine that is available without a prescription. CEFALY is safe, well-tolerated, and clinically proven.

    About the CEFALY device:

    CEFALY Technology is the maker of CEFALY, an FDA-cleared, over-the-counter wearable medical device clinically proven to help reduce migraine frequency and relieve migraine pain. CEFALY is a non-invasive device placed on the forehead to modify pain sensation in the area research identifies as a center for migraine pain, the trigeminal nerve. The device offers two distinct treatment options — a 60-minute ACUTE setting that serves as an abortive treatment for pain relief at the onset of a migraine, which is clinically proven to stop or reduce migraine pain during an attack; and a 20-minute PREVENT setting for daily use to help prevent future episodes.

    About CEFALY Technology:

    CEFALY Technology is a Belgium-based company with U.S. offices based in Darien, Conn., specializing in electronics for medical applications. CEFALY Technology’s mission is to provide innovative, ever-evolving technology that enables people with migraine to take control of their treatment and live happier, healthier lives.

    Learn more about CEFALY by visiting www.CEFALY.com and following us on FacebookTwitter, LinkedInInstagram and TikTok.

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    Cefaly Technology

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  • The 6 Best Cold Laser Therapy Devices of 2023, Medically Reviewed

    The 6 Best Cold Laser Therapy Devices of 2023, Medically Reviewed

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    The idea of applying a laser to your skin can make some people apprehensive. This handheld low-level laser comes with a kit containing everything you could possibly need, including a simple set of rules to follow. A great option for people who haven’t used cold laser therapy before, this device is easy to incorporate into your everyday life. 

    This device has been cleared by the FDA to be used a few times a day as needed. Each time you use it, the light stimulates injured cells and causes them to respond at a higher rate. The intended result: Pain relief, improved circulation, and an accelerated healing process. 

    The brand recommends that you start with the lowest laser strength power level (170mW) two to three times per day for a total of 15 minutes. Then, during your second week of use, you can try the second power level (340mW) two to three times per day for up to 20 to 25 minutes. Finally, after three weeks, you can go ahead and use the third power setting (510mW) two to three times a day for a total of 30+ minutes, as desired. Again, if you are unsure about the right treatment plan for you, consult with a medical professional.

    There are also two wavelength modes to choose from: continuous and pulse. The continuous wavelength mode emits a fixed laser energy the entire time you’re using it. Pulsed diodes, on the other hand, emit a high intensity laser in short-yet-powerful bursts of energy. It’s the high-powered level during each pulse that drives the light energy deep into the target tissue. The peak power of a pulsed laser can be higher than that of a continuous laser, making it a more effective treatment in a shorter time span. 

    This cold laser therapy device does not have a ton of reviews yet, but the feedback it does have is positive. People comment on the efficacy and say it has made a considerable difference in their pain management. One writes, “A friend loaned me her device for my dog who had major knee surgery. It worked to reduce inflammation and helped the healing process. I’ve also used it on my back and had such a positive experience with it, I’m buying myself one.” 

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    Caitlyn Martyn

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  • Study suggests one solution to America’s opioid epidemic: Tell doctors their patients fatally overdosed

    Study suggests one solution to America’s opioid epidemic: Tell doctors their patients fatally overdosed

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    Newswise — There are no simple solutions to America’s deadly overdose epidemic, which costs 100,000 lives each year and is erasing gains in life expectancy. But a team of USC researchers have found one low-cost intervention can make a difference: a letter notifying providers their patient has died from an overdose.

    A 2018 study by the team found that notifying clinicians through an informational letter from their county’s medical examiner that a patient had suffered a fatal overdose reduced the number of opioid prescriptions they wrote over the next three months. The team’s new study, published today in JAMA Network Open, shows those notifications have a lasting impact up to a year later.

    “Clinicians don’t necessarily know a patient they prescribed opioids to has suffered a fatal overdose,” said lead author Jason Doctor, Chair of the Department of Health Policy and Management at the USC Sol Price School of Public Policy and Co-Director of the Behavioral Sciences Program at the USC Schaeffer Center for Health Policy & Economics. “We knew closing this information loop immediately reduced opioid prescriptions. Our latest study shows that change in prescribing behavior seems to stick.”

    A simple public health intervention with a lasting impact

    Doctor and his team sent letters to 809 clinicians—predominantly medical doctors—who had prescribed opioids to 166 people who had suffered fatal overdoses in San Diego County. The letter was intended to be informative and respectful in tone while providing information about safer prescribing. The researchers compared prescribing patterns among these clinicians to those who had not received the letter.

    While there was a gradual reduction in opioid prescribing across the board, study authors found the rate of the reduction was faster and more robust among those who received the letter. After one year, those who received the letter wrote 7% fewer prescriptions than clinicians who hadn’t received the notification.

    “The new study shows this change is not just a temporary blip and then clinicians went back to their previous prescribing,” said Doctor. “This low-cost intervention has a long-lasting impact.”

    Doctor acknowledged that attention to the number of deaths from drugs prescribed by clinicians has been eclipsed by the focus on rising deaths from illicit opioid use, particularly during the COVID-19 pandemic.

    “The sad truth is, we never addressed the first problem of deaths from prescribed opioids. In fact, it’s all mixed together because nationally, approximately half of people who die of an illicit fentanyl drug overdose have also had an opioid prescription within the past year,” he explained.

    Medical examiners are uniquely positioned to mitigate future opioid overdose deaths

    The big takeaway, said Doctor, is the letters from the medical examiner provide a unique opportunity to get into communication with physicians in the wake of overdose deaths to save lives from both legal and illegal opioids.

    “The letter is a nudge to providers that the opioid epidemic is in their community and affecting their patients. It is easy to read the headlines and assume you are not part of the problem,” said Doctor. “Doctors have an opportunity to talk to their patients and consider alternatives to opioids. I believe we can reach about half of the people in the illicit fentanyl epidemic through a doctor who has seen them.”

    Doctor and other study authors are currently partnering with Los Angeles County on lessons from the research and looking at potential public policy interventions, including mandating such notifications from county medical examiners to clinicians.

    About the study

    Additional study authors include Emily Stewart and Tara Knight of the USC Schaeffer Center; Roneet Lev of the Scripps Mercy Hospital San Diego; Jonathan Lucas of the Department of Medical Examiner-Coroner of the County of Los Angeles; Andy Nguyen of Global Blood Therapeutics, South San Francisco; and Michael Menchine of the Department of Emergency Medicine at UCLA. The work was supported by the California Health Care Foundation (grant 19413) to Doctor, Stewart and Knight; the National Institute on Aging (NIA) at the National Institutes of Health (grants R21-AG057395-01 and R33-AG057395 to Knight); National Institute on Drug Abuse (R01 DA046226) and the NIA Roybal Center for Behavioral Interventions (P30AG024968 to Knight).

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    University of Southern California (USC)

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  • Nearly 1/3 of people with chronic pain turn to cannabis

    Nearly 1/3 of people with chronic pain turn to cannabis

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    Newswise — As more U.S. states legalize cannabis (also known as marijuana) for medical and recreational use, increasing numbers of people are experimenting with it for pain relief. According to a new study published in JAMA Network Open, almost a third of patients with chronic pain reported using cannabis to manage it.

    More than half of the 1,724 adults surveyed reported that using cannabis led them to decrease the use of pain medications, including prescription opioids and over-the-counter analgesics. Cannabis also effected the use of other non-drug related pain relief methods to various degrees: some people indicated that cannabis led them to turn less often to techniques that many clinical guidelines recommend as first-line therapies such as physical therapy and cognitive behavioral therapy, while others with chronic pain increased their use of such treatments.

    “The fact that patients report substituting cannabis for pain medications so much underscores the need for research on the benefits and risk of using cannabis for chronic pain,” said Mark Bicket, M.D., Ph.D., Assistant Professor in the Department of Anesthesiology and Co-Director of the Michigan Opioid Prescribing Engagement Network.

    Paper cited: “Use of cannabis and other pain treatments among adults with chronic pain in US states with medical cannabis programs,” JAMA Network Open. DOI: 10.1001/jamanetworkopen.2022.49797

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    Michigan Medicine – University of Michigan

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  • I Put Everyone Else First, Until A NDE Inspired Me To Change

    I Put Everyone Else First, Until A NDE Inspired Me To Change

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    So much inflammation accumulated in my body that it began to damage my own tissue internally. I discovered this was happening because I’d had breast augmentation, and my body started to reject the foreign substance. Because of that, I had a lot of damaged tissue and the implants ruptured as a result—so I needed to have surgery to remove all of it. 

    After that surgery, I constantly felt sick, and I knew something was off. But I didn’t have too many tangible, visible symptoms, so it was hard to describe to doctors what was going wrong. I felt exhausted and miserable from the moment I woke up in the morning. All the tests doctors ran came back inconclusive, except they found I had an elevated white blood cell count. 

    Eventually, the doctors suspected I had MRSA, a stubborn bacteria, resistant to most antibiotics. Because of its nature, MRSA lingers, and when it colonizes inside of you, it’s difficult to eliminate. The infection had taken over a big part of my chest area, near my heart—I kept having surgeries to try and get it out, but they were unsuccessful.

    Alongside all of these physical health issues, I still hadn’t dealt with the psychological and emotional side of what happened with my family. So here I am, with layers of unresolved trauma.

    Then, during one of my surgeries, I almost died on the table. I’d lost so much blood that I had turned gray, and the surgeon wasn’t sure if he could continue. But he carried on and took the risk and ultimately ended up saving me. 

    During that entire illness experience, and while recovering from surgery, I remember feeling like I’d fallen so far from my path and purpose. So I made a commitment to myself: I was going to shift gears and focus on my own healing, in order to find my way back.

    As a nutritionist, I already knew what I needed to do to optimize what I was eating, so I got very deliberate about filling my body with nourishing foods. I also focused on moving my body in a healthy way.

    In addition to all of this, I began focusing on my spiritual journey and started working with a healer on a regular basis. She helped me understand where I was experiencing imbalances and stuck energy.

    Inspired by what I learned from her, I decided to pursue and study reiki—an ancient healing energy modality—to help with my own journey. 

    From there, everything really came together for me. After focusing on my health journey, and accelerating the healing in my own body (physical, emotional, mental, energetic), I was able to shorten my own recovery by weeks, which shocked my doctors.

    Ultimately, I was able to combine what my healer taught me, my reiki education, and my knowledge of nutrition to create Culinary Alchemy, my practice that combines integrative and functional nutrition with energy work and mindfulness practices to help people find sustainable holistic health.

    Since then, I’ve been able to expand my work and help support so many people in their healing journeys—many of whom are recovering from surgery. By allowing me to put myself first and prioritize my own healing, I was able to ultimately help so many others, in a sustainable way. 

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    Serena Poon CN, CHC, CHN

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  • Randomized trial finds therapies for spine pain improved disability and quality of life but did not decrease healthcare spending

    Randomized trial finds therapies for spine pain improved disability and quality of life but did not decrease healthcare spending

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    Newswise — Pain in the back or the neck is extremely common and accounts for more healthcare spending than any other health condition. A study led by investigators from Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, compared two non-invasive interventions for treating spine pain, assessing both how well these methods worked at reducing pain and whether either method reduced spine-related healthcare spending. In a clinical trial of 2,971 participants, patients with spine pain were randomized to receive usual care or one of two interventions. The first intervention used the identify, coordinate and enhance (ICE) model, in which patients receive specialized counseling, physical therapy and a specialist in pain medicine or psychiatry consults with their primary care physician. The second intervention was individualized postural therapy (IPT), a technique that attempts to realign and rebalance spinal muscles to relieve pain. Compared to usual care, both interventions provided a small but significant improvement in pain-related disability after three months. These changes were sustained and clinically meaningful at 12 months, long after the interventions were over.  Both interventions reduced resource utilization (such as diagnostic imaging, procedures, and specialist visits). Overall, the ICE intervention lowered spine-related spending by $139 per person compared to usual care (p=0.04), although this difference was not statically significant at the threshold used in the trial. Spine-related spending for the IPT intervention was significantly higher than usual care.

    “Both methods examined in this clinical trial led to small but meaningful reductions in pain-related disability,” said corresponding author Niteesh Choudhry, MD, PhD, executive director for BWH’s Center for Healthcare Delivery Sciences and a practicing hospitalist. “Given the high cost of spine-related healthcare spending, it is critically important to find cost-effective ways to effectively improve pain management.”

    Read more in JAMA.

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    Brigham and Women’s Hospital

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  • Wastewater samples show the dramatic effects of tough love on codeine addicts as consumption plunges

    Wastewater samples show the dramatic effects of tough love on codeine addicts as consumption plunges

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    Newswise — Switching the painkiller codeine to a prescription-only medicine in 2018 led to a 37 per cent overall drop in its consumption across Australia, according to new findings from wastewater sampling published in the journal Addiction.

    The samples, taken from 49 wastewater treatment plants, which cover catchment areas for 10.6 million Australians, show the dramatic effect of withdrawing the country’s most misused legal opioid from pharmacy counters, cutting dependency, and potentially saving lives.

    Scientists from the University of South Australia and University of Queensland compared wastewater samples taken between 2016 and 2019, 18 months before and after codeine was rescheduled and low-dose formulations removed from over-the-counter (OTC).

    Codeine concentrations were converted to per capita consumption estimates, revealing an immediate decrease of 37 per cent nationally after the rescheduling and between 24 per cent and 51 per cent in all states and territories.

    UniSA scientist Associate Professor Cobus Gerber says the samples – representing 45 per cent of the country’s population – demonstrate the effectiveness of the Federal Government’s decision to take tough measures on the popular painkiller.

    Opioids are among the most widely used analgesic medicines globally, with more than 61 million people using them in 2018.

    Their misuse is responsible for two thirds of all drug-related deaths, due to abuse and dependence.

    Codeine has been the most widely used legal opioid in Australia, with its per capita use steadily increasing. 2013 data showed Australia took more codeine as a country than the United States, despite having roughly seven per cent of the population.

    In 2013, the proportion of OTC codeine products was estimated at 40 per cent of total painkillers stocked in pharmacies.

    The Therapeutic Goods Administration estimated that, prior to 2018, OTC codeine sales were responsible for more than 100 deaths each year, taking a lead from many other countries to remove codeine from pharmacy counters, given the significant medical issues associated with its use.

    Lead author, University of Queensland researcher Dr Ben Tscharke, says “less availability not only means less chance for codeine to be misused, but also changing the perception of codeine being a harmless drug. Making it prescription-only sends a clear message about how dangerous it is.”

    “Codeine is typically prescribed for short-term, acute pain management but there was anecdotal evidence that many people used it as a first-line treatment and for extended periods, without consulting a doctor.”

    The wastewater samples showed that regional areas decreased by a smaller margin than cities, possibly because more people in rural and regional locations obtained a script after the change, and patients in metropolitan areas had more pain alternatives to choose from, including non-medicinal treatments.

    South Australia and Tasmania had the smallest decreases – averaging 25 per cent – and the Northern Territory the largest decrease of 51 per cent.

    Prior to rescheduling, codeine rates of use were approximately 25 per cent higher in regional areas.

    National sales of codeine during the study period were not as close to wastewater estimates, showing a combined 50 per cent decrease in total packs of codeine sold nationally (high strength 37 per cent drop and low strength 80 per cent drop).

    Researchers attribute the difference to consumption delays due to stockpiling.

    Similar reductions were observed in monthly calls to poison call centres, where poisonings halved after the rescheduling of codeine.

    Colder climates (ACT, Victoria and Tasmania) had a greater variance between winter and summer codeine consumption before rescheduling. This may be attributed to more chronic and age-related ailments in winter, causing pain.

    “Wastewater monitoring is not able to provide conclusive reasons for consumer behaviour, but it does show the effectiveness of interventions, such as codeine rescheduling,” the researchers say.

    The study is the first to evaluate a national drug policy change via wastewater sampling.

    Notes for editors

    “A wastewater-based evaluation of the effectiveness of codeine control measures in Australia” is published in Addiction.

    It can be accessed at: https://onlinelibrary.wiley.com/doi/10.1111/add.16083?af=R#:~:text=Wastewater%20analysis%20shows%20that%20codeine,to%20changes%20in%20drug%20scheduling.

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    University of South Australia

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  • I Struggled With Undiagnosed Chronic Gut Pain For 31 Years

    I Struggled With Undiagnosed Chronic Gut Pain For 31 Years

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    As a child, I remember experiencing regular pain that would come on like stomach discomfort. Then, right afterward, my digestion would get really bad. These symptoms would usually be accompanied by a whole host of autoimmune issues, too. All of this would ultimately manifest as a week of feeling sick and uncomfortable.

    When I was 12, I watched my mother get sober. In my family, there are a lot of individuals with substance use disorders, and it was a really impactful moment in my life to see someone navigate their mental health and become the person I always hoped they could be. Observing my mom’s journey was incredibly inspiring, and as a teenager, it propelled me on my own path exploring the mental health side of my physical symptoms. 

    Still, while I was discovering just about every mental health modality I could, my chronic pain symptoms continued to get worse and worse. Doctors gave me every test under the sun, but no one could provide answers. The lack of a diagnosis started to lead me down a dark spiral. I was so diligent about trying to alleviate my symptoms, and I was desperate for clarity about my experience.

    At one point, I received a potential diagnosis of Crohn’s. I immersed myself in information about the disease, trying to learn everything I could, only to find out it was actually a misdiagnosis. I was crushed.

    As the years went on, the pain progressed. It would come on like a stomachache, but then within 30 minutes, it would escalate to an overwhelming, all-consuming pain. I lived a 10-minute walk from the emergency room, and it got to the point where I would end up there three or four nights a week. I would show up writhing in pain, and they would just put me on a morphine drip for some relief. Fortunately, I had so much awareness around mental health and addiction—but I could understand how people with chronic pain became dependent on certain medications.

    It was in these dark moments, whenever the pain would get really bad, I would begin to wonder if I wasn’t supposed to be here. 

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    Payton Nyquvest

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  • A handy lesson about pain and the brain in stroke survivors

    A handy lesson about pain and the brain in stroke survivors

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    Newswise — A world-first study of stroke survivors shows how chronic pain can alter body perception, with the brain tricking patients into believing their affected hand is a different size, increasing the risk of accidents.

    Australian and US researchers found there’s a strong likelihood in stroke patients with persistent pain to mistakenly believe their stroke-affected hand is either bigger or smaller than it really is. The findings are published in a landmark paper in Brain Sciences.

    Researchers, including international pain expert Professor Lorimer Moseley AO from the University of South Australia, surveyed 523 stroke survivors, finding that those living with chronic pain were almost three times as likely as pain free survivors to experience altered body perception.

    The results suggest that rehabilitation to address distorted body perception in stroke survivors may improve outcomes, given that stroke is a leading cause of disability worldwide and accurate perception of hand size is critical to holding or manipulating objects.

    “There are two striking findings in our study,” Professor Moseley says.

    “First, that three out of five stroke sufferers are living with chronic pain, which is up to 300 per cent higher than in the general population.

    “Second, that those with pain are also more likely to perceive major changes in how their body feels to them. This is a potential double whammy, making daily activities more difficult and affecting quality of life,” Prof Moseley says.

    Both stroke and persistent pain (lasting longer than three months) are associated with impaired cognition, more fatigue, anxiety and depression, and distortions in body perception might amplify these conditions, he says.

    Distorted body perception has been reported in a range of conditions – after amputation, severe chronic pain and eating disorders – but has not previously been linked to pain after stroke.

    “The next step is to identify whether body perception disturbance is contributing to pain in these patients. If it is, we need to devise treatments to address this.”

    Distorted body perception was twice as likely when post-stroke pain was in the hand, which is consistent with other chronic pain populations such as knee osteoarthritis, where up to 30 per cent of people believe their knee is swollen when it isn’t.

    “These remarkable findings show us that we are perhaps more complex creatures than we previously thought,” Prof Moseley says.

    The researchers did not find any link between chronic pain and strokes occurring on a specific side of the body.

    Notes for editors

    “My Hand is Different”: Altered body perception in stroke survivors with chronic pain” is published in Brain Sciences. It is authored by researchers from the University of Melbourne, La Trobe University, the University of South Australia and University of California, San Francisco.

    The paper is available at: https://www.mdpi.com/2076-3425/12/10/1331

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    University of South Australia

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  • Ease Aches & Pains From Home With The 5 Best TENS Units For Back Pain

    Ease Aches & Pains From Home With The 5 Best TENS Units For Back Pain

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    The best way to ensure you’re using your TENS unit for back pain correctly is to speak with a medical professional. Any reputable machine should come with extensive instructions—and this is not an instance where you want to skip the instruction manual. “TENS is a relatively safe treatment, so long as those instructions are followed,” Starkey confirms.

    That said, before you decide to charge up your TENS unit, Starkey says you’ll want to make sure you have an understanding of where your pain is coming from. “It’s cliché, but TENS (or anything else) should not be used to treat pain of unknown origin or used for more than two weeks without being examined by a medical professional.”

    As for pad placement during sensory level pain control (no muscle contraction), Starkey recommends an “X” pattern with the painful area at the center of the X. The electrodes on each set of wires should be placed so that the current crosses over the area in pain.

    In terms of frequency of use, “Sensory-level pain control can be used for days at a time,” Starkey advises. He recommends moving the electrodes slightly with each use to avoid irritation from the adhesive. 

    The TENS unit should feel like a tingle or buzz that gradually increases in intensity to a sharp, prickly sensation. If the TENS treatment is successful, you should feel some pain relief within the first 30 minutes of treatment. If it is not successful, change the electrode placements and try again. And if you’re seeking 24-hour pain control, portable units are best.

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    Mark Barroso, MS, LAT, ATC, CSCS, NSCA-CPT

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  • After Years of Ankle Pain and Limited Mobility, Life-Changing Surgery at HSS

    After Years of Ankle Pain and Limited Mobility, Life-Changing Surgery at HSS

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    Newswise — After years of searching for answers and numerous doctor consultations, 59-year-old Kathleen Kaler finally found relief from the severe ankle pain and instability that had plagued her for years. At Hospital for Special Surgery (HSS), Constantine Demetracopoulos, MD, performed successful ankle replacement surgery.

    Kaler, who is from Long Island, says the surgery changed her life. She can now engage in activities most people take for granted – walking normally without pain, wearing shoes she likes, being able to do her job, working in her backyard.

    “You have no idea how grateful I am. Before the surgery, my left ankle was collapsing, it could barely support my weight,” says Kaler, a slim 5 foot 7. “All my shoes were worn out on one side.” Her ankle was so unstable, she lived in fear that she would fall or break it, despite the rigid plastic brace she wore from her foot to her knee, day in and day out. She could only wear one type of shoe that she needed to replace every three months.

    As a child, Kaler recalls constantly twisting her ankle. Her parents took her to several doctors, and she was given a shoe insert to help with her high foot arches. Years later, arthritis set in, and the pain worsened and became more debilitating. Cortisone shots could only do so much, and she resumed the search for a long-lasting solution. Four doctors said nothing could be done. One orthopedic surgeon said the problem might be corrected with four separate surgeries, which she declined.

    Then she learned about total ankle replacement during an appointment with a doctor at HSS Long Island. It’s a complex surgery performed by relatively few orthopedic surgeons, and she was referred to Dr. Demetracopoulos, director of the HSS Total Ankle Replacement Center at the main hospital in Manhattan.

    “One of the few centers of its kind, we have a team of foot and ankle specialists, anesthesiologists, radiologists, nurses and physical therapists who have extensive experience in ankle replacement,” he explains. “We strive to provide the best possible care for each of our patients and have grown our volume to become one of the top institutions nationwide in ankle replacement.”

    Kaler says her consultation with Dr. Demetracopoulos gave her hope, and she would not be disappointed. She had the surgery in April 2021. “He saved my life. I never cry, but I cried in front of him, I was so grateful,” she says.

    “Ankle replacement is considered when patients are no longer able to manage arthritis pain with nonsurgical treatments such as physical therapy, appropriate footwear, an ankle brace or anti-inflammatory medication,” Dr. Demetracopoulos explains. “They have consistent pain that limits their activities and affects their quality of life.”

    Like other types of joint replacements, the surgery involves replacing the damaged bone and cartilage in the ankle with a prosthesis. The implant, made of metal and plastic, has the shape of a natural joint and seeks to provide normal, pain-free movement.

    The last 15 years have brought vast improvements in ankle replacement implants, technology and surgical techniques, making it a viable option for many patients suffering from severe arthritis, says Scott Ellis, MD, another orthopedic surgeon specializing in foot and ankle surgery at HSS.

    One of the most noteworthy advances in ankle replacement is patient-specific instrumentation, or PSI, Dr. Ellis says. It entails obtaining a CT scan of the patient’s ankle and developing a customized presurgical plan tailored to the individual’s anatomy. “PSI has been a game changer. It enables us to choose an implant that is the perfect size and map out a very precise surgery for optimal alignment and positioning,” he says.

    For people considering an ankle replacement, the first step is a thorough assessment of the ankle and the foot, and a discussion of patient goals and expectations. Imaging and other tests determine if a patient is a candidate. For someone whose ankle is very stiff with limited mobility or a severe deformity, a fusion of the ankle bones might be a better option and is also very successful in relieving pain, the HSS experts say. An ankle fusion would also be a better option for someone with weakened bones or osteoporosis. The benefit of ankle replacement over fusion is better movement after surgery.

    Sometimes an ankle replacement needs to be combined with another procedure, as it was in Kaler’s case. “Hers was a complex surgery. She had a type of foot that predisposed her to ankle instability,” Dr. Demetracopoulos explained. “In addition to treating her arthritis with the ankle replacement, we needed to treat the instability by repairing the ligaments in her ankle and by correcting the alignment in her foot, so it was in the right position.” 

    Kaler says she experienced no pain after surgery, which Dr. Demetracopoulos attributes to advances in nerve block anesthesia and pain management protocols after the procedure. He notes that each patient experiences pain differently, though.

    The HSS doctors expect 90 percent of ankle replacements to last 10 years. If the implant wears out, patients could be candidates for a revision ankle replacement or an ankle fusion. The physicians follow and monitor patients in a joint replacement registry at HSS. “One of our core missions at HSS is not only to deliver the care and do the best surgery we can for our patients, but to collect data over time that we can share with other surgeons and clinicians,” Dr. Demetracopoulos says.

    Kaler says the surgery has enabled her to regain her confidence. She can now drive her stick-shift Mini Cooper and carry out her demanding job responsibilities at a major home improvement store. “I’m all over the place, to the point where my friends and colleagues are saying, ‘slow down,’” she adds, making up for lost time and living life to the fullest.

    About HSS

    HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New JerseyConnecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

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  • Positive media coverage of cannabis studies regardless of therapeutic effect

    Positive media coverage of cannabis studies regardless of therapeutic effect

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    Newswise — In cannabis trials against pain, people who take placebos report feeling largely the same level of pain relief as those who consume the active cannabinoid substance. Still, these studies receive significant media coverage regardless of the clinical outcome, report researchers from Karolinska Institutet in Sweden in a study published in JAMA Network Open.

    “We see that cannabis studies are often described in positive terms in the media regardless of their results,” says the study’s first author Filip Gedin, postdoc researcher at the Department of Clinical Neuroscience, Karolinska Institutet. “This is problematic and can influence expectations when it comes to the effects of cannabis therapy on pain. The greater the benefit a treatment is assumed to have, the more potential harms can be tolerated.”

    The study is based on an analysis of published clinical studies in which cannabis has been compared with placebo for the treatment of clinical pain. The change in pain intensity before and after treatment were the study’s primary outcome measurement.

    The analysis drew on 20 studies published up to September 2021 involving almost 1,500 individuals.

    The results of the study show that pain is rated as being significantly less intense after treatment with placebo, with a moderate to large effect. The researchers also observed no difference in pain reduction between cannabis and placebo, which corroborates results from another recently published meta-analysis. 

    “There is a distinct and clinically relevant placebo response in studies of cannabis for pain,” says Dr Gedin.

    The researchers also examined a possible connection between the magnitude of the therapeutic effect shown by the cannabis studies and the coverage they receive in the media and in academic journals. Media presence was measured through Altmetric, which is a method of evaluating mentions in the media, in blogs and on social media. Academic impact was measured in terms of citations by other researchers.

    The analysis of media presence included a total of 136 news items in traditional media and in blogs and was categorised as positive, negative or neutral, depending on how the results were presented concerning the effectiveness of cannabis as a treatment for pain.

    The researchers found that the cannabis studies received much greater media attention than other published studies. The coverage was substantial regardless of the magnitude of the placebo response and regardless of the therapeutic effect of cannabis. They also observed no link between the proportion of positively described news about a study and the effect it reported. 

    The researchers add the caveat that their study combined trials of varying designs and quality and therefore the results should be interpreted with caution.

    This research was financed by Riksbankens Jubileumsfond (Karin Jensen). The researchers report no potential conflicts of interest.

    Publication: “Placebo Response and media attention in randomized clinical trials assessing cannabis-based therapies for pain: A systematic review and meta-analysis”, Filip Gedin, Sebastian Blomé, Moa Ponten, Maria Lalouni, Jens Fust, Andreé Raquette, Viktor Vadenmark Lundquist, William H. Thompson and Karin Jensen, JAMA Network Open, online 28 November, 2022, doi: 10.1001/jamanetworkopen.2022.43848

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  • Quarter of former Olympians suffer from osteoarthritis, study says

    Quarter of former Olympians suffer from osteoarthritis, study says

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    Newswise — One in four retired Olympians reported a diagnosis of osteoarthritis, the form of arthritis that causes changes in the joint and can lead to discomfort, pain and disability, the research found.

    Elite retired sportspeople who had experienced a sports-related injury had a higher chance of knee and hip osteoarthritis when compared with the general population.

    The athletes – who had competed at an Olympic level in 57 sports including athletics, rowing and skiing – also had an increased risk of lower back pain overall, and shoulder osteoarthritis after a shoulder injury.

    Researchers hope the findings will help develop new approaches in injury prevention for the benefit of athletes now and in retirement.

    The study – led by a University of Edinburgh based researcher – is the largest international survey of its kind, and the first to observe the consequences of osteoarthritis and pain in different joints from retired elite athletes across different summer and winter Olympic sports.

    Researchers quizzed 3,357 retired Olympians aged around 45 on injuries and the health of their bones, joints, muscles and spine. They were also asked if they were currently experiencing joint pain, and if they had an osteoarthritis diagnosis.

    For comparison, 1,735 people aged around 41 from the general population completed the same survey.

    Researchers used statistical models to compare the prevalence of spine, upper limb and lower limb osteoarthritis and pain in retired Olympians with the general population.  

    The team considered factors that could influence the risk of pain and osteoarthritis such as injury, recurrent injury, age, sex and obesity.

    They found that the knee, lumbar spine and shoulder were the most injury prone areas for Olympians. These were also among the most common locations for osteoarthritis and pain.

    After a joint injury the Olympians were more likely to develop osteoarthritis than someone sustaining a similar injury in the general population, the research found

    The sportspeople also had an increased risk of shoulder, knee, hip and ankle and upper and lower spine pain after injury, although this did not differ with the general population.

    Dr Debbie Palmer, of the University of Edinburgh’s Moray House School of Education and Sport, said: “High performance sport is associated with an increased risk of sport-related injury and there is emerging evidence suggesting retired elite athletes have high rates of post-traumatic osteoarthritis.

    “This study provides new evidence for specific factors associated with pain and osteoarthritis in retired elite athletes across the knee, hip, ankle, lumbar and cervical spine, and shoulder, and identifies differences in their occurrence that are specific to Olympians.”

    Researchers say the study may help people make decisions about recovery and rehabilitation from injuries in order to prevent recurrences, and to inform prevention strategies to reduce the risk and progression of pain and OA in retirement.

    Two linked studies are published in the British Journal of Sports Medicine.

    Open access version of the paper are available here: Part 1 –https://www.research.ed.ac.uk/en/publications/prevalence-of-and-factors-associated-with-osteoarthritis-and-pain

     Part 2 – https://www.research.ed.ac.uk/en/publications/prevalence-of-and-factors-associated-with-osteoarthritis-and-pain-2

    The World Olympians Association funded the Retired Olympian Musculoskeletal Health Study with a research grant from the International Olympic Committee.

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  • Vitamin D fails to reduce statin-associated muscle pain

    Vitamin D fails to reduce statin-associated muscle pain

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    • About 30 to 35 million Americans are prescribed statins to lower cholesterol
    • It’s common for patients to complain of muscle pain when taking statins 
    • Some doctors recommend vitamin D to ease these muscle aches, but new study found no benefit 

    Newswise — CHICAGO — Patients who take statins to lower high cholesterol levels often complain of muscle pains, which can lead them to stop taking the highly effective medication and put them at greater risk of heart attack or stroke. 

    Some clinicians have recommended vitamin D supplements to ease the muscle aches of patients taking a statin, but a new study from scientists at Northwestern University, Harvard University and Stanford University shows the vitamin appears to have no substantial impact.

    The study will be published Nov. 23 in JAMA Cardiology.

    Although non-randomized studies have reported vitamin D to be an effective treatment for statin-associated muscle symptoms, the new study, which is the first randomized clinical trial to look at the effect of vitamin D on statin-associated muscle symptoms, was large enough to rule out any important benefits.

    In the randomized, double-blind trial, 2,083 participants ingested either 2,000 units of vitamin D supplements daily or a placebo. The study found participants in both categories were equally likely to develop muscle symptoms and discontinue statin therapy. 

    Over 4.8 years of follow-up, statin-related muscle pain was reported by 31% of the participants assigned vitamin D and 31% assigned a placebo. 

    “We had high hopes that vitamin D would be effective because in our clinic and across the country, statin-associated muscle symptoms were a major reason why so many patients stopped taking their statin medication,” said senior author Dr. Neil Stone, professor of medicine in cardiology and preventive medicine at Northwestern University Feinberg School of Medicine and a Northwestern Medicine cardiologist. “So, it was very disappointing that vitamin D failed a rigorous test. Nevertheless, it’s important to avoid using ineffective treatments and instead focus on research that can provide an answer.” 

    Statins and vitamin D supplements are two of the most commonly used medications in American adults. About 30 to 35 million Americans are prescribed statins, and about half of the population aged 60 and older take a vitamin D supplement. 

    “We took advantage of a large placebo-controlled randomized trial to test whether vitamin D would reduce statin-associated muscle symptoms and help patients keep taking their statins,” said lead study author Dr. Mark Hlatky, a professor of health policy and cardiovascular medicine at Stanford. “The placebo control in the study was important because if people think vitamin D is supposed to reduce their muscle pains, they just might feel better while taking it, even if vitamin D has no specific effect.”                                                                                               

    Trial was a sub study within a larger clinical trial

    The 2,083 patients were among the larger cohort of participants in the VITamin D and Omega-3 Trial (VITAL), which randomized nearly 26,000 participants to double-blind vitamin D supplementation to determine whether it would prevent cardiovascular disease and cancer. This provided researchers a unique opportunity to test whether vitamin D reduces muscle symptoms among participants who initiated statins during the follow-up period of the larger VITAL trial. The mean age of the study participants was 67, and 51% were women.

    “Randomized clinical trials are important because many very good ideas don’t work as well as we had hoped when they are put to the test,” Hlatky said. “Statistical associations do not prove a cause-and-effect relationship. Low levels of vitamin D are associated with many medical problems, but it turns out that giving people vitamin D does not generally fix those problems.”

    For patients who report statin-associated muscle pains

    Dr. Stone noted that sometimes the secret for understanding patients who have difficulty with statins is analyzing other medications they’re taking, determining whether or not they have associated metabolic or inflammatory conditions, counseling them on their ability to hydrate adequately and, importantly, discussing “pill anxiety.” 

    “For those who have difficulties with statins, a systematic appraisal by a physician with experience in dealing with these matters is still very important,” Stone said.

    The idea for this sub study arose out of conversations between study co-author Dr. Pedro Gonzalez, then a resident at Northwestern Memorial Hospital, and Dr. Stone, who runs a large lipid clinic at Northwestern.

    Other authors of the study include JoAnn E. Manson and the VITAL study group at Brigham and Women’s Hospital, Harvard Medical School and the Harvard T. H. Chan School of Public Health.

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  • Treating Inoperable Lung Cancer: A Nurse’s Perspective

    Treating Inoperable Lung Cancer: A Nurse’s Perspective

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    By Alison Massey, as told to Susan Bernstein

    There is a perception that chemotherapy is like treatments from 20 or 30 years ago. They think it will have side effects that are not tolerable, but we have made significant advances in managing the toxicities that come with these cancer medications. People think chemo will make them sick, but that’s not the case. Each individual treatment regimen has its own side effect profile. If you look at the list of possible side effects, people can be overwhelmed. Most people will experience a side effect, but no one gets every possible side effect.

    Generally, people will be a little tired or have a dip in energy level for a few days. But between your treatments, we hope that you’ll be able to live your normal life. We have many people who continue to work between their treatments.

    Nausea is another common side effect, but we’ve made advances in how to manage nausea you may experience around your treatments as well. We can offer patients a range of anti-nausea medications. Some treatments do cause hair loss, and if that’s the case, we let you know that up front. It’s important to note that the vast majority do not cause hair loss, although some may cause hair thinning. We definitely have ways to help you manage these issues, including offering a prescription for wigs or other resources. With hair thinning, we can also check certain labs or get our dermatology colleagues involved to help you.

    Fatigue is the main thing you may experience with radiation. Radiation can cause inflammation in your body as it kills the cancer. It’s the inflammation that causes the side effects. Depending on what is being radiated, you may have pain. For example, if you are receiving lung radiation, your esophagus can be involved because the radiation may be close to that area of your body. If so, you may have pain with swallowing or difficulty swallowing. You may even feel like food gets stuck after you swallow it. People who are having radiation may not realize that it could affect swallowing food.

    Sometimes people will need radiation to a painful lesion. While receiving radiation at a particular spot for people with advanced lung cancer, you may have a flare-up of that pain. Ultimately, the hope is that pain will disappear. During this time, we can also treat you with pain medications or steroids like dexamethasone to minimize the inflammation that causes pain.

    Checkpoint inhibitors [immunotherapy medications for lung cancer] can have side effects, but they are different than chemo because they act on your immune system. These medications can overactivate your immune system, which leads to the side effects. Sometimes, we see patients develop dermatitis, which appears as a rash, or experience colitis that causes diarrhea, or pneumonitis of your lungs, which may cause shortness of breath or a cough. Checkpoint inhibitors may also cause arthritis or myositis, which is inflammation of your muscles. Sometimes, we can even see swelling of your joints. It’s important that if patients notice any new symptoms while taking a checkpoint inhibitor, they let us know about it so we can initiate treatment. The quicker you tell us about these side effects, the sooner we can treat and reverse them.

    Anxiety and depression are two things we deal with very often during cancer treatment. In my experience, people may feel lost when they are first diagnosed. But once you have found your oncologist and your whole cancer support team, and you know you have a plan of attack to treat your cancer, most people feel better. Many have a fear of cancer treatments and the potential impact of treatment on your quality of life. We let people know that they can still live their life and they should continue to do the things that they enjoy.

    Your mood and outlook may depend on where you are in your cancer treatment course or disease progression. Early on, most people are more functional and have less fatigue. Some people may still be able to work. Others may need to hang out at home for a few days after each treatment. Our goal is that you don’t stay in bed the whole time you’re being treated for cancer. Keep an active schedule as much as you can. Realize that you will be tired after your treatment and plan for those days. And don’t forget to ask for help if you need it!

    Sleeping well can also affect your mood and quality of life. A lot of our patients have insomnia. Often anxiety may be causing that insomnia. Your mind is racing, so you can’t sleep. Also, some of the meds you take for nausea or steroids for inflammation can rev you up and cause insomnia. And sometimes an annoying cough can disrupt your sleep.

    Some people with lung cancer may need to use supplemental oxygen. In my experience, people struggle with the idea of wearing oxygen because, like the association with hair loss, now people on the outside are able to see that they are sick. But from a medical perspective, it’s important to wear it if you need it.

    Loss of sexual function is something we can see in both men and women. In my experience, men are more vocal about this, so speak up, ladies, if you have any concerns! Erectile dysfunction can affect men during cancer treatment. Women may experience vaginal dryness or pain during intercourse. If that happens and you let us know, we can refer you to a sexual health doctor. Treatments can also affect women’s menstrual cycles. If you’re someone who could get pregnant, you should be careful to use contraception while you’re being treated for cancer.

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  • Why Does Chronic Pain Hurt So Much?

    Why Does Chronic Pain Hurt So Much?

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    You never forget the first time a doctor gives up: when they tell you that they don’t know what to do—they have no further tests to run, no treatments to offer—and that you’re on your own. It happened to me at the age of 27, and it happens to many others with chronic pain.

    I don’t remember what film I’d gone to see, but I know I was at The Oaks Theater, an old arts cinema on the outskirts of Pittsburgh, when pain stabbed me in the side. This was followed by an urgent need to urinate; after bolting to the bathroom, I felt better, but a band of tension ran through my groin. As the hours went by, the pain resolved into a need to pee again, which woke me up at 1 or 2 a.m. I went to the bathroom—but, as if I was in some bad dream, urinating made no difference. The band of sensation remained, insusceptible to feedback from my body. I spent a night of hallucinatory sleeplessness sprawled on the bathroom floor, peeing from time to time in a vain attempt to snooze the somatic alarm.

    My primary-care doctor guessed that I had a urinary-tract infection. But the test came back negative—as did more elaborate tests, including a cystoscopy in which an apparently teenage urologist inserted an old-fashioned cystoscope through my urethra in agonizing increments, like a telescopic radio antenna. It certainly felt like something was wrong, but the doctor found no visible lesion or infection.

    What followed were years of fruitless consultations, the last of which produced a label, chronic pelvic pain—which means what it sounds like and explains very little—and a discouraging prognosis. The condition is not well understood, and there is no reliable treatment. I live with the hum of pain as background noise, flare-ups decimating sleep from time to time.

    That pain is bad for you may seem too obvious to warrant scrutiny. But as a philosopher, I find myself asking why it is so bad—especially in a case like mine, where the pain I feel from day to day is not debilitating. To my relief, I am able to function pretty well; sleep deprivation is the worst of it. What more is there to say about the harm of being in pain?

    Virginia Woolf may have invented the commonplace that language struggles to communicate pain. “English, which can express the thoughts of Hamlet and the tragedy of Lear,” she wrote, “has no words for the shiver and the headache.” Woolf’s maxim was developed by the literary and cultural critic Elaine Scarry in The Body in Pain, a book that has become a classic. “Physical pain—unlike any other state of consciousness—has no referential content,” she wrote. “It is not of or for anything. It is precisely because it takes no object that it, more than any other phenomenon, resists objectification in language.”

    But as someone who has lived with pain for 19 years, I think Woolf and Scarry are wrong. Physical pain has “referential content”: It represents a part of the body as being damaged or imperiled even when, as in my case, it isn’t really. Pain can be deceptive. And we have many words for it: Pulsing, burning, and contracting are all good words for mine.

    That pain represents the body in distress, bringing it into focus, helps us better understand why it is bad. Pain disrupts what the philosopher and physician Drew Leder calls the “transparency” of the healthy body. We don’t normally attend to the bodies itself; instead, we interact with the world “through” it, as if it was a transparent medium. Being in pain blurs the corporeal glass. That’s why pain is not just bad in itself: It impedes one’s access to anything good.

    This accounts for one of pain’s illusions. Sometimes, I think I want nothing more than to be pain free—but as soon as pain is gone, the body recedes into the background, unappreciated. The joy of being free of pain is like a picture that vanishes when you try to look at it, like turning on the lights to see the dark.

    Philosophy illuminates another side of pain—in a way that has practical upshots. This has to do with understanding persistent pain as more than just a sequence of atomized sensations. The temporality of pain transforms its character.

    Although I am not always in notable pain, I’m never aware of pain’s onset or relief. By the time I realize it has vanished from the radar of attention, it has been quiet for a while. When the pain is unignorable, it seems like it’s been there forever and will never go away. I can’t project into a future free of pain: I will never be physically at ease. Leder, who also suffers from chronic pain, traces its effects on memory and anticipation: “With chronic suffering a painless past is all but forgotten. While knowing intellectually that we were once not in pain we have lost the bodily memory of how this felt. Similarly, a painless future may be unimaginable.”

    We can draw two lessons from this. The first is that we have to focus on the present, not on what is coming in the future: If you can treat pain as a series of self-contained episodes, you can diminish its power. I try to live by what I call the “Kimmy Schmidt rule,” after the sitcom heroine who endured 15 years in an underground bunker with the mantra “You can stand anything for 10 seconds.” My units of time are longer, but I do my imperfect best not to project beyond them. You can have a good day while experiencing pelvic pain. And life is just one day after another.

    The second lesson is that there’s less to what philosophers call “the separateness of persons” than might appear. Moral philosophers have argued that concern for others does not simply aggregate their harms. If you have to choose between agony for one person or mild headaches for many others, you should choose the headaches, no matter the number. The relief of minor pain for many cannot offset the agony of one, because the pains afflict distinct and separate people. They don’t add up.

    Do trade-offs like this make sense within a single life? Philosophers often say they do, but I’ve come to believe that’s wrong. If what I was experiencing was just a sequence of atomized pains, without effects on memory or anticipation, I don’t think it would make sense to trade them for short-lived agony—a three-hour surgery performed without anesthetic, say—any more than it would make sense to trade a million mild headaches for the agony of one person. If I would choose to undergo that surgery, it would be because of the temporal effects of chronic pain, the shadow it casts over past and future.

    A lot has been made of pain’s unshareability, how it divides us from one another. In fact, pain is no more shareable over time. My mother-in-law once asked, rhetorically, “Why can one man not piss for another man?” But you can’t piss for your past or future self either. And as we bridge the gulf between now and then to sympathize with ourselves at other times, we sympathize too with the suffering of others. Self-compassion is not the same as compassion for other people, but they are not as different as they seem. There is solace in solidarity, in sharing the experience of chronic pain, in compassion’s power to breach the boundaries that separate us from other people, and ourselves.

    This article has been excerpted from Kieran Setiya’s new book, Life Is Hard: How Philosophy Can Help Us Find Our Way.

    When you buy a book using a link on this page, we receive a commission. Thank you for supporting The Atlantic.

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  • Green eyeglasses reduce pain-related anxiety in fibromyalgia patients, study shows

    Green eyeglasses reduce pain-related anxiety in fibromyalgia patients, study shows

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    Newswise — NEW ORLEANS — Wearing special green eyeglasses for several hours a day reduces pain-related anxiety and may help decrease the need for opioids to manage severe pain in fibromyalgia patients and possibly others who experience chronic pain, according to a study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

    “Our research found that certain wavelengths of green light stimulate the pathways in the brain that help manage pain,” said Padma Gulur, M.D., lead author of the study and executive vice chair of Duke Anesthesiology and Duke Health, Chapel Hill, North Carolina. “There is an urgent need for additional treatments to reduce the use of opioids among patients with fibromyalgia and other types of chronic pain, and green eyeglasses could provide an easy-to-use, non-drug option.”

    Few alternatives to opioids — especially non-drug options — exist for patients with severe and chronic pain conditions such as fibromyalgia, which causes pain all over the body. Fibromyalgia affects about 4 million U.S. adults, according to the Centers for Disease Control and Prevention. 

    Pain and anxiety share similar biological mechanisms. Additionally, fear of pain exacerbates anxiety, often leading to increased opioid use, said Dr. Gulur. 

    The researchers studied 34 fibromyalgia patients who were randomized to wear various shades of eyeglasses four hours a day for two weeks: 10 patients wore blue eyeglasses, 12 wore clear eyeglasses and 12 wore green eyeglasses. Patients who wore green eyeglasses were four times more likely to have reduced anxiety than those in the other groups, which saw no reduction in anxiety. 

    “We found that although their pain scores remained the same, those who wore the green eyeglasses used fewer opioids, demonstrating that their pain was adequately controlled,” said Dr. Gulur. “We would recommend the green eyeglasses treatment for those with fibromyalgia and are studying patients with other chronic pain conditions to determine if it would be beneficial.”  

    The eyeglasses are specially formulated to filter a specific wavelength on the green light spectrum, said Dr. Gulur. She noted that most patients who wore the green eyeglasses reported feeling better and asked to keep wearing them.

     

    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS

    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. 

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/MadeforThisMoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.


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  • Cannabis use increases pain after surgery, study shows

    Cannabis use increases pain after surgery, study shows

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    Newswise — NEW ORLEANS — Adults who use cannabis have more pain after surgery than those who don’t use cannabis, according to a study presented at the ANESTHESIOLOGY® 2022 annual meeting

    “Cannabis is the most commonly used illicit drug in the United States and increasingly used as an alternative treatment for chronic pain, but there is limited data that shows how it affects patient outcomes after surgery,” said Elyad Ekrami, M.D., lead author of the study and clinical research fellow of the Outcomes Research Department at Cleveland Clinic’s Anesthesiology Institute. “Our study shows that adults who use cannabis are having more — not less — postoperative pain. Consequently, they have higher opioid consumption after surgery.” 

    Researchers analyzed the records of 34,521 adult patients — 1,681 of them cannabis users — who had elective surgeries at Cleveland Clinic from January 2010 to December 2020. The cannabis users had used the drug within 30 days before surgery, while the other patients had never used cannabis. The patients who used cannabis experienced 14% more pain during the first 24 hours after surgery compared to the patients who never used cannabis. Additionally, patients who used cannabis consumed 7% more opioids after surgery, which the authors note was not statistically significant, but is likely clinically relevant.  

    “The association between cannabis use, pain scores and opioid consumption has been reported before in smaller studies, but they’ve had conflicting results,” Dr. Ekrami added. “Our study has a much larger sample size and does not include patients with chronic pain diagnosis or those who received regional anesthesia, which would have seriously conflicted our results. Furthermore, our study groups were balanced by confounding factors including age, sex, tobacco and other illicit drug use, as well as depression and psychological disorders.”

    Dr. Ekrami noted that additional research is needed to further define cannabis’ effects on surgical outcomes. “Physicians should consider that patients using cannabis may have more pain and require slightly higher doses of opioids after surgery, emphasizing the need to continue exploring a multimodal approach to post-surgical pain control,” he said.  


    THE AMERICAN SOCIETY OF ANESTHESIOLOGISTS
    Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 55,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. 

    For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Join the ANESTHESIOLOGY® 2022 social conversation today. Like ASA on Facebook, follow ASALifeline on Twitter and use the hashtag #ANES22.

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    American Society of Anesthesiologists (ASA)

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  • Radiation Therapy for High-Risk, Asymptomatic Bone Metastases May Prevent Pain and Prolong Life

    Radiation Therapy for High-Risk, Asymptomatic Bone Metastases May Prevent Pain and Prolong Life

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    Newswise — SAN ANTONIO, October 23, 2022 — Treating high-risk, asymptomatic bone metastases with radiation may reduce painful complications and hospitalizations and possibly extend overall survival in people whose cancer has spread to multiple sites, a phase II clinical trial suggests. Results of the multicenter, randomized trial (NCT03523351) will be presented today at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

    The clinical trial findings suggest radiation oncologists may play a valuable role in treating widespread bone metastases even in the absence of symptoms. Palliative radiation has historically focused on reducing existing pain and other symptoms when a patient’s cancer is no longer considered curable. Investigators hoped to show that painful complications could be prevented by treating asymptomatic bone metastases with radiation and were surprised to find the benefits may extend beyond comfort.

    “It’s thought-provoking that radiation to prevent pain could potentially prolong life,” said Erin F. Gillespie, MD, lead author of the study and a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York. “It suggests that treating to cure the cancer is not the only thing that can help people live longer.”

    The study arose from the observation that many patients hospitalized for painful bone metastases have evidence of these lesions on imaging scans several months earlier, Dr. Gillespie said. Although external beam radiation therapy is standard-of-care for painful lesions, it has not been used for asymptomatic ones outside of the oligometastatic setting; generally, patients remain on systemic therapy until lesions become symptomatic. Dr. Gillespie and her colleagues wanted to determine “if and when we might intervene before these symptoms occur to prevent hospitalizations and debility from cancer.”

    For the study, researchers identified 78 adults with a metastatic solid tumor malignancy and more than five metastatic lesions, including at least one asymptomatic high-risk bone lesion. Whether a lesion was high-risk was determined by its size (if it was 2 centimeters or more in diameter); its location in the junctional spine; whether it involved the hip or sacroiliac joint; or if it was in one of the long bones of the body, such as those found in arms and legs. Between all enrolled patients, there were a cumulative 122 bone metastases.

    Among study participants, the most common types of primary cancer were lung (27%), breast (24%) and prostate (22%). Participants were randomly assigned to receive standard treatment, which could include systemic treatment (such as chemotherapy or targeted agents) or observation, with or without radiation therapy to treat all of their high-risk bone metastases. Radiation doses varied but were typically low (i.e., not ablative). All patients were followed for at least 12 months or until they succumbed to their disease.

    The primary endpoint was to determine whether treating asymptomatic lesions could prevent skeletal-related events (SREs) – a common and often painful and debilitating complication of bone metastases. SREs include pain, fractures and compression of the spinal cord that requires surgery or radiation. They can contribute to a higher risk of death and higher health care costs.

    Researchers found that treating the asymptomatic lesions with radiation reduced the number SREs and SRE-related hospitalizations and extended overall survival, compared to people who received no radiation. At the end of one year, for patients on the radiation arm, SREs occurred in 1 of 62 lesions (1.6%), compared to 14 of 49 lesions (29%) for those receiving standard care (p<0.001). Significantly fewer patients in the radiation arm were hospitalized for SREs (0 vs. 4, p=0.045).

    After a median 2.4 years of follow-up, overall survival was significantly longer for patients who received radiation therapy, compared to those who did not (hazard ratio 0.50, 95% confidence interval 0.28-0.91, p=0.02). Median overall survival was 1.1 years for the 11 patients who experienced an SRE, compared to 1.5 years for the 67 patients who had no SREs.

    After the first three months, patients in the radiation arm reported less pain than those in the standard care arm (p<0.05), a trend that continued but was no longer statistically significant for the remainder of the study. There were no significant differences in quality of life between the two arms at any point in the study.

    Though it was not in the initial study design, Dr. Gillespie said the team performed an unplanned analysis of which lesions were most likely to cause SREs. While they expected to find those in the long bones might cause more fractures and pain, they found it was metastases in the spine that were most likely to cause subsequent pain, cord compression or fracture. However, the numbers are small and will require further evaluation to confirm.

    Treating those lesions with “even low doses of radiation seemed adequate to prevent the lesion from progressing and causing problems,” Dr. Gillespie said.

    Dr. Gillespie emphasized that because of the study’s small size, its findings, while hypothesis-generating, were not definitive and a larger study is needed to replicate and expand on these analyses. “Our trial results add to a growing field of study examining the potential of early supportive care, but they still need to be confirmed in a larger phase III trial,” she explained.

    She also said future research should seek to answer questions such as: “Does this apply to someone early in the course of their metastatic disease who may not have any symptomatic lesions? At what point would they benefit from intervention with radiation? There are many patients with multiple sites of metastases, but how do we identify those lesions that are most likely to become problematic?”

    “And, once we confirm this is the right thing to do,” she said, “how do we ensure patients who might benefit get access to this treatment?”

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    Attribution to the American Society for Radiation Oncology (ASTRO) Annual Meeting is requested in all coverage. View the meeting press kit at www.astro.org/annualmeetingpress.

    See this study presented:

    • Prophylactic radiation therapy versus standard-of-care for patients with high-risk, asymptomatic bone metastases: A multicenter, randomized phase II trial (Abstract LBA 04)
    • News Briefing: Tuesday, October 25, 9:00 a.m. Central time. Details here.
    • Scientific Presentation: Clinical Trials Session, Sunday, October 23, 10:40 a.m. Central time, Henry B. Gonzalez Convention Center. Details here; email [email protected] for access.

     

    ABOUT ASTRO

    The American Society for Radiation Oncology (ASTRO) is the largest radiation oncology society in the world, with nearly 10,000 members who are physicians, nurses, biologists, physicists, radiation therapists, dosimetrists and other health care professionals who specialize in treating patients with radiation therapies. For information on radiation therapy, visit RTAnswers.org. To learn more about ASTRO, visit our website and media center and follow us on social media.

     

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