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Chronic Pain

Chronic Pain (5)

02 Nov

Chickenpox has an evil counterpart in shingles, a much more sinister outbreak caused by the same varicella-zoster virus. Once the virus is in your system from a bought of chicken pox, shingles becomes a looming threat – especially later in life. And, to make it worse, the condition brings with it the possibility of long-term chronic pain, a condition known as postherpetic neuralgia. But, with the proper information and treatment, it’s possible to effectively manage (and even prevent) these conditions and relieve the associated pain.

Who’s at Risk?

Anyone who’s had chickenpox is at risk for shingles, however there are certain factors that make it more likely for the virus to be reactivated. Advancing age, a weakened immune system, illness and stress can all cause an outbreak.[1]

While not all people who get shingles will get postherpetic neuralgia, there is a substantial risk – especially for older individuals. According to Columbia University Medical Center, about 40% of people older than 60 experience postherpetic pain, while less than 10% of those younger than 60 are likely to develop it.[2] Individuals may also have a greater risk if their shingles outbreak was particularly severe, if their outbreak was on their face or torso or if they have a chronic illness (like diabetes).[1] However, this risk decreases if people begin a course of antiviral medication within three days of developing the shingles rash.

Symptoms and Causes

Shingles results in a painful rash and blisters, which are often preceded by pain. These symptoms should usually clear up within two to four weeks.[3] In postherpetic neuralgia, however, this pain continues even when the rash and blisters are gone. This happens if the shingles virus damages your nerve fibers. Since damaged fibers can’t properly communicate messages between the skin and the brain, the messages become confused and exaggerated, which your brain interprets as intense pain. The pain usually improves over time, but can take months – or even years – to resolve.[1]

It can often feel like a burning, sharp or jabbing feeling and can make your skin extremely sensitive to touch. Even clothes rubbing against the skin can become unbearable. The condition may also be accompanied by fatigue, depression and difficulty sleeping or concentrating.

Prevention and Treatment

Since 2006, a shingles vaccine has been available and is now recommended for those 60 and older, whether or not they remember having the chickenpox. The vaccine is also recommended for those who have already had shingles in order to prevent future occurrences. According to the CDC, this vaccine can reduce the risk of shingles by 51% and the risk of postherpetic neuralgia by 67%.3 Protection from the vaccine lasts about five years.

While there’s no way to cure postherpetic neuralgia, there are various ways to reduce the pain to make the condition more bearable. Columbia University suggests seeking out a comprehensive, multidisciplinary pain management-oriented approach when dealing with the lingering pain.[2] This type of approach may include pain-relieving skin patches or creams, anticonvulsants, TENS therapy or antidepressants, in addition to behavioral health services. While opioids may sometimes be prescribed, they’re typically less effective than other medications and have dangerous side effects.[2] Interventional procedures, including nerve blocks or spinal cord stimulation (for severe cases), may also be considered to provide a higher degree of pain relief.

If you or a loved one is experiencing chronic pain related to shingles, it’s important to see a doctor as soon as possible. To speak to a care team specialist or to schedule an appointment to discuss your condition, call (888) 901-PAIN (7246).

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] Mayo Clinic. “Postherpectic Neuralgia.” September 16, 2015. Accessed January 17, 2017. http://www.mayoclinic.org/diseases-conditions/postherpetic-neuralgia/basics/prevention/con-20023743.

[2] Columbia University Department of Neurological Surgery. “Postherpetic Neuralgia.” Accessed January 17, 2017. http://www.columbianeurosurgery.org/conditions/postherpetic-neuralgia/.

[3] CDC. “Shingles (Herpes Zoster) Vaccine & Preventable Disease.” November 22, 2016. Accessed January 17, 2017. https://www.cdc.gov/vaccines/vpd/shingles/.

02 Nov

It’s well-known in the medical world that the drugs often prescribed to treat pain – morphine, oxycodone and other opioids – can actually make patients more sensitive to pain (a side effect called hyperalgesia). But a study published in May in the Proceedings of the National Academy of Sciences[1] found even more evidence of the serious side effects of opioids – especially when prescribed at the onset of pain. The authors discovered that these drugs, when administered after a nerve injury, actually doubled the duration of the pain.

Overview of the Study

 “Pain after disease/damage of the nervous system is predominantly treated with opioids, but without exploration of the long-term consequences,” the study says. So to delve further into these consequences – particularly to test their hypothesis that morphine may contribute to “persistent sensitization,” as they call it – the study’s authors conducted a study on rats whose sciatic nerves (a nerve running down their hind legs) had been painfully constricted.

Ten days after the constriction, the rats were given either saline or morphine for five days. Over the next three months, the rats’ sensitivity to pain was tested.[2] The researchers found that the rats who received saline returned to normal sensitivity levels within about six weeks, while those who had morphine took 12 weeks to recover (in addition to experiencing increased sensitivity overall).  

The data, the authors concluded, showed that not only can morphine amplify pain (hyperalgesia), but it can also seriously prolong it, even after the treatment is stopped. This seems to be due to an inflammatory response taking place in the spinal cord.

Limitations

There are several limitations to the study. Since the study was undertaken on rats, there is no guarantee that the process works the same way in humans. In addition, the rats were genetically similar – and all male – meaning that the human reaction to morphine may not be so homogeneous (although there is unpublished data that supports the idea that morphine could extend pain even longer for female rats).[3]

Implications

Researchers are already working on drugs and methods to intercept and reverse the inflammatory response caused by morphine. In fact, this study also found that by inhibiting the inflammatory responses, they could permanently reset the amplified pain to normal levels. This could prove useful down the road in making opioids more effective – thus requiring lower doses and lessening the chances of overdose. 

However, for the time being, this study reinforces the already strong indication that opioids should be prescribed with caution. Their large number of serious side effects, paired with the lack of evidence showing any long-term benefit,[4] suggests the need for other treatments to deal with pain. Minimally invasive procedures or complementary treatments – like physical therapy or behavioral health – may help to fill this gap.

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[1] Grace, Peter M., Keith A. Strand, Erika L. Galer, Daniel J. Urban, Xiaohui Wang, Michael V. Baratta, Timothy J. Fabisiak, Nathan D. Anderson, Kejun Cheng, Lisa I. Greene, Debra Berkelhammer, Yingning Zhang, Amanda L. Ellis, Hang Hubert Yin, Serge Campeau, Kenner C. Rice, Bryan L. Roth, Steven F. Maier, and Linda R. Watkins. "Morphine Paradoxically Prolongs Neuropathic Pain in Rats by Amplifying Spinal NLRP3 Inflammasome Activation." Proceedings of the National Academy of Sciences 113, no. 24 (May 2016).

[2] Servick, Kelly. "Why Taking Morphine, Oxycodone Can Sometimes Make Pain Worse." American Association for the Advancement of Science. May 30, 2016. Accessed July 19, 2016. http://www.sciencemag.org/news/2016/05/why-taking-morphine-oxycodone-can-sometimes-make-pain-worse.

[3] Sanders, Laura. "Morphine May Make Pain Last Longer." Science News. May 30, 2016. Accessed July 19, 2016. https://www.sciencenews.org/article/morphine-may-make-pain-last-longer.

[4] Dowell, Deborah, Tamara M. Haegerich, and Roger Chou. "CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016." Morbidity and Mortality Weekly Report (MMWR) 65, no. 1 (March 18, 2016): 1-49.

02 Nov

Many studies have reported that children of parents suffering from chronic pain are more likely to develop it themselves. They’re also more likely to experience negative mental and physical health outcomes due to that chronic pain. But so far, the reasons as to why this occurs aren’t entirely understood. In a recent report,[1] two researchers put forth a conceptual model exploring possible reasons for this connection, which could help address – or even prevent – the transmission of chronic pain to the next generation.

About the Report

The report, titled “Transmission of risk from parents with chronic pain to offspring,” was published on May 31 in the journal PAIN, the official publication of the International Association for the Study of Pain (IASP).

It was undertaken because “although the association between chronic pain in parents and offspring has been established, few studies have addressed why or how this relation occurs.” The study authors thus set out to create a conceptual model that could be useful in developing preventative interventions, with the goal of stopping the transmission.

Conceptual Model

The comprehensive model delved into five areas that could be involved in the transmission of pain, as well as the negative mental and physical outcomes that accompany it.

  1. Genetics. What parents pass down to their children on a biological level obviously has a place in the transmission of pain, as well as the psychological components that accompany it (like depression and anxiety). The study said that genetic factors may actually account for half of the risk of chronic pain in adults.
  2. Early neurobiological development. The way a child’s nervous system develops may be impacted by a parent with chronic pain. For instance, if a mother is dealing with the stress, depression or lack of activity brought about by pain while she is pregnant, it could affect the baby’s development.
  3. Pain-specific social learning. The “learning theory” poses that all behavior – whether good or bad – is learned. Thus some elements of the pain experience may be learned as well, such as parents’ maladaptive pain behaviors. One example of this is catastrophizing: Children see their parents’ exaggerated worries and responses to pain and subconsciously learn to mimic them.
  4. General parenting and health habits. Both the attitudes adults take toward parenting and their own health could rub off on their children, making them more susceptible to chronic pain down the road. Permissive parenting or a lack of consistency and warmth could affect future pain, the study theorized. Likewise, poor exercise and dietary habits could be passed down to children, resulting in chronic pain.
  5. Exposure to a stressful environment. Experiencing increased stress while growing up may play into chronic pain as an adult. For instance, having parents who constantly worry about financial issues or who are unable to complete daily tasks may impact the risk of developing chronic pain.

The study stated that “the outlined mechanisms, moderators, and vulnerabilities likely interact over time to influence the development of chronic pain and related outcomes in offspring of parents with chronic pain.” So by the time children are grown, these factors – or a subset of them – likely lead to a higher risk of developing long-lasting pain conditions. The authors’ hopes were that by highlighting these methods of transmission, they might open up new avenues for prevention amongst at-risk children.

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[1] Stone, Amanda, and Anna Wilson. "Transmission of Risk from Parents with Chronic Pain to Offspring: An Integrative Conceptual Model." PAIN (2016).

 

01 Nov

There is no doubt that chronic pain changes a person; the physical and emotional effects are often readily apparent. Yet a less well-known, but equally serious effect of pain is that it actually changes the brain, causing emotional and cognitive impairment and deficits that can further hinder your ability to live a full and rewarding life. Fortunately, recent studies have shown that with effective treatment for pain, our brains can heal along with our bodies, resulting in a restoration of brain functioning.

Altered Brain Morphology

Chronic pain doesn’t just affect a singular region of the brain, but in fact results in changes to multiple important regions, which are involved in many critical functions and processes. Various studies over the years have found changes to the hippocampus, in addition to reduction of gray matter in the dorsolateral prefrontal cortex, amygdala, brainstem and right insular cortex, to name a few.[1][2][3] A breakdown of some of these areas and their related functions may help to put these cerebral changes into context.

Hippocampus

The hippocampus is part of the brain’s limbic system, which helps regulate emotional responses.[4] Particularly, it is thought to be associated with the formation of new memories relating to facts and events, and spatial processing, or your brain’s ability to map the layout of your environment.

In a 2012 study, researchers found that those experiencing chronic back pain and complex regional pain syndrome (CRPS) had “significantly less bilateral hippocampal volume.”[1] They concluded that this may be associated with both learning and emotional deficits.

As part of the study, the team completed several tests on mice with and without chronic pain. The results showed that mice with pain experienced both increased fear and anxiety when compared to mice without pain. This was due, in part, to their inability to properly form memories relating to context, in addition to a generally increased fear of unfamiliar situations. The decreased hippocampal volume is likely to cause similar effects in humans, particularly increased anxiety and both learning and memory problems.

Bilateral Dorsolateral Prefrontal Cortex

Chronic pain, specifically low back pain, has also been found to decrease the gray matter in an area in the brain known as the bilateral dorsolateral prefrontal cortex (DLPFC). This area, located in the front of the brain, is responsible for what are known as executive functions,[5] like the ability to remember past events and use them to help you act in similar situations in the present, and the ability to assess and adjust your actions based on the their outcomes.

In a 2011 Journal of Neuroscience study, they found that although the decreased DLPFC did not hinder people’s ability to complete tasks, it did change the way their brain reacted when faced with a challenge. Essentially, those with chronic pain had to use more of their brains to complete the exact same task. In other words, pain makes it more difficult for the brain to process information and problems.

Reversible Changes

Pain’s effects on the brain may seem overwhelming, but there’s good research to suggest that the changes are not permanent; they can be reversed when patients receive treatment for their painful conditions. “Gray matter abnormalities found in chronic pain,” a 2009 study concluded, “do not reflect brain damage, but rather are a reversible consequence … which normalizes when the pain is adequately treated.”[3] The 2011 study concurred, suggesting that “treating chronic pain can restore normal brain function in humans.”[2]

Seeking effective pain treatments, like those offered by Advanced Pain Management, can not only reduce pain levels, but also improve your cognitive functioning. Less pain, better emotional responses and improved cognitive function are all at your fingertips. Why wait?

 

[1] Mutso, A. A., D. Radzicki, M. N. Baliki, L. Huang, G. Banisadr, M. V. Centeno, J. Radulovic, M. Martina, R. J. Miller, and A. V. Apkarian. "Abnormalities in Hippocampal Functioning with Persistent Pain." Journal of Neuroscience 32, no. 17 (October 25, 2012): 5747-756.

[2] Seminowicz, D. A., T. H. Wideman, L. Naso, Z. Hatami-Khoroushahi, S. Fallatah, M. A. Ware, P. Jarzem, M. C. Bushnell, Y. Shir, J. A. Ouellet, and L. S. Stone. "Effective Treatment of Chronic Low Back Pain in Humans Reverses Abnormal Brain Anatomy and Function." Journal of Neuroscience 31, no. 20 (May 18, 2011): 7540-550.

[3] Rodriguez-Raecke, Rea, Andreas Niemeier, Kristin Ihle, Wolfgang Ruether, and Arne May. "Brain Gray Matter Decrease in Chronic Pain Is the Consequence and Not the Cause of Pain." Journal of Neuroscience 29, no. 44 (November 04, 2009): 13746-3750.

[4] Yassa, Michael A. "Hippocampus." Encyclopedia Britannica Online. 2016. Accessed March 10, 2016. http://www.britannica.com/science/hippocampus.

[5] Miller, Bruce L., and Jeffrey L. Cummings. The Human Frontal Lobes: Functions and Disorders. New York: Guilford Press, 1999.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

31 Oct

At first, pain seems like an inconvenience, one you hope will go away with time and rest. But the longer it lasts, the more bothersome pain becomes until it seems to affect every corner of your life. In reality, chronic pain can lead to issues far beyond the immediate pain itself. Here are five ways pain can wreak havoc on your life.

  1. Pain limits activity levels, which can lead to a further reduction in overall health. In a 2004 study, 28% of adults experiencing back pain limited their activity.[1] And this holds true for people of all ages, from youths[2] to older individuals.[3] Lack of activity and exercise, in turn, can lead to weight gain, which can worsen many chronic pain conditions.
  2. Pain has been proven to weaken the immune system. This can slow healing and make us less resistant to infection and disease.[4] Pain is particularly linked with higher rates of cancer recurrence and mortality, especially for those with breast, head and neck, lung and colorectal cancers.

  3. Pain leads to an inability to concentrate. In a study of individuals with chronic spinal pain, 17.3% experienced problems with concentration, while 20.2% had issues with memory.[5] This may be, in part, due to the altered brain morphology caused by pain, which leads to various cognitive and emotional difficulties. This side effect of pain seems to be even more common among individuals taking opioids. In one comprehensive study of such patients, 70% of respondents reported difficulty concentrating.[6] This inability to concentrate can have innumerable effects on life. In one study of pain patients, it was found that problems in concentration and memory “were related to emotional distress, poor family support and interference with daily activities.”[7]
  4. Pain may be sapping your motivation. If you often find yourself thinking “Why bother?” it may be because of changes in key parts of the brain due to pain. In a study of mice published in the journal Science,[8] researchers found that hungry mice with chronic pain were less likely to work hard for food, despite being physically capable. Even when the pain was temporarily relieved, their motivation didn’t return. This was due to a permanent change in the brain region known as the nucleus accumbens.

  5. Pain is linked to serious psychological distress. Research last year from the University of California in Irvine and UCLA suggests that there may be a direct link between pain and depression, anxiety and substance abuse, which are seen in at least half of long-term pain patients.[9] This may be due, in part, to brain inflammation in various regions brought about by chronic nerve pain. The resulting symptoms may be a contributing factor to the high suicide rate among chronic pain sufferers, which is second only to bipolar disorder as an illness-related cause of suicide.

These effects of pain can be devastating, causing both emotional and physical issues for pain sufferers. It’s important, then, that in treating pain, each of these issues is addressed. That’s where a multidisciplinary approach comes in. Through interventional procedures, physical therapy and behavioral health care, among other complementary components, individuals with chronic pain can get moving again, shaking off the haze of depression, returning to a healthy, active lifestyle and once again embracing the things they love.

Get moving. Call (888) 901-PAIN (7246) or click to schedule a consultation now.

[1] U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. “Health, United States, 2006. With Chartbook on Trends in the Health of Americans.” 2006. Accessed June 8, 2016. http://www.cdc.gov/nchs/data/hus/hus06.pdf

[2] Rabbitts, Jennifer A., Amy Lewandowski Holley, Cynthia W. Karlson, and Tonya M. Palermo. "Bidirectional Associations Between Pain and Physical Activity in Adolescents." The Clinical Journal of Pain 30, no. 3 (March 2014): 251-58.

[3] Mackichan, F., J. Adamson, and R. Gooberman-Hill. "'Living within Your Limits': Activity Restriction in Older People Experiencing Chronic Pain." Age and Ageing 42, no. 6 (November 2013): 702-08.

[4] Page, Gayle G. “The Immune-Suppressive Effects of Pain.” Madame Curie Bioscience Database. Accessed June 8, 2016. http://www.ncbi.nlm.nih.gov/books/NBK6140/

[5] Melkumova, K. A., E. V. Podchufarova, and N. N. Yakhno. "Characteristics of Cognitive Functions in Patients with Chronic Spinal Pain." Neuroscience and Behavioral Physiology 41, no. 1 (January 2011): 42-46.

[6] Michaelson, David. “Voices of Chronic Pain.” American Pain Foundation. May 2006. Accessed June 8, 2016. http://www.davidmichaelsoncompany.com/documents/voices%20of%20chronic%20pain%20report.pdf

[7] Jamison, R. N., T. Sbrocco, and W. C. Parris. "The Influence of Problems with Concentration and Memory on Emotional Distress and Daily Activity in Chronic Pain Patients." The International Journal of Psychiatry in Medicine 18, no. 2 (1989): 181-91.

[8] "Study Reveals Brain Mechanism behind Chronic Pain's Sapping of Motivation." Stanford.edu. July 31, 2014. Accessed June 08, 2016. https://med.stanford.edu/news/all-news/2014/07/study-reveals-brain-mechanism-behind-chronic-pains-sapping-of-mo.html.

[9] "UC Study Links Brain Inflammation Triggered by Chronic Pain to Anxiety and Depression." University of California Irvine. June 9, 2015. Accessed June 08, 2016. https://news.uci.edu/campus-life/students/uc-study-links-brain-inflammation-triggered-by-chronic-pain-to-anxiety-and-depression/.

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