Santa Rosa: (707) 623-9803
Petaluma: (707) 623-9803
Sonoma: 707-623-9803

Men remember pain differently than do women

Scientists increasingly believe that one of the driving forces in chronic pain — the number one health problem in both prevalence and burden — appears to be the memory of earlier pain. Research published today/this week in Current Biology suggests that there may be variations, based on sex, in the way that pain is remembered in both mice and humans.

The research team, led by colleagues from McGill and University of Toronto Mississauga, found that men (and male mice) remembered earlier painful experiences clearly. As a result, they were stressed and hypersensitive to later pain when returned to the location in which it had earlier been experienced. Women (and female mice) did not seem to be stressed by their earlier experiences of pain. The researchers believe that the robust translational nature of the results, from mice to men, will potentially aid scientists to move forward in their search for future treatments of chronic pain.

It was a discovery that came as a total surprise.

Robust results in mice and men

“We set out to do an experiment looking at pain hypersensitivity in mice and found these surprising differences in stress levels between male and female mice,” explains Jeffrey Mogil, the E.P. Taylor Professor of Pain Studies in McGill’s Department of Psychology and Alan Edwards Centre for Research on Pain who is the senior author on the study. “So we decided to extend the experiment to humans to see whether the results would be similar. We were blown away when we saw that there seemed to be the same differences between men and women as we had seen in mice.”

“What was even more surprising was that the men reacted more, because it is well known that women are both more sensitive to pain than men, and that they are also generally more stressed out,” explains Loren Martin, the first author on the paper and an Assistant Professor of Psychology at the University of Toronto Mississauga.

Creating memories of pain in humans and mice

In experiments with both humans and mice, the subjects (41 men and 38 women between the ages of 18-40 in the case of humans) were taken to a specific room (or put in a testing container of a certain shape — depending on the species) where they experienced low levels of pain caused by heat delivered to their hind paw or forearm. Humans rated the level of pain on a 100-point scale and mice “rated” the pain by how quickly they moved away from the heat source. Immediately following this initial experience of low-level pain, subjects experienced more intense pain designed to act as Pavlovian conditioning stimuli. The human subjects were asked to wear a tightly inflated blood pressure cuff and exercise their arms for 20 minutes. This is excruciating and only seven of the 80 subjects rated it at less than 50 on a 100-point scale. Each mouse received a diluted injection of vinegar designed to cause a stomach ache for about 30 minutes.

In order to look at the role that memory plays in the experience of pain, the following day the subjects returned to either the same or a different room, or to the same or a different testing container. Heat was once again applied to their arms or hind paws.

When (and only when) they were taken into the same room as in the previous test, the men rated the heat pain higher than they did the day before, and higher than the women did. Similarly, male, but not female mice returning to the same environment exhibited a heightened heat pain response, while mice placed in a new and neutral environment did not.

“We believe that the mice and the men were anticipating the cuff, or the vinegar, and, for the males, the stress of that anticipation caused greater pain sensitivity,” says Mogil. “There was some reason to expect that we would see increased sensitivity to pain on the second day, but there was no reason to expect it would be specific to males. That came as a complete surprise.”

Blocking memories makes the pain go away

In order to confirm that pain was increased due to memories of previous pain, the researchers interfered with memory by injecting the brains of male mice with a drug called ZIP that is known to block memory. When the researchers then ran the pain memory experiment, these mice showed no signs of remembered pain.

“This is an important finding because increasing evidence suggests that chronic pain is a problem to the extent that you remember it , and this study is the first time such remembered pain has been shown using a translational — both rodent and human subject — approach,” says Martin, who is also the Tier II Canada Research Chair in Translational Pain Research. “If remembered pain is a driving force for chronic pain and we understand how pain is remembered, we may be able help some sufferers by treating the mechanisms behind the memories directly.”

Mogil echoes this optimism, “This research supports the idea that the memory of pain can affect later pain.” He adds, “I think it is appropriate to say that further study of this extremely robust phenomenon might give us insights that may be useful for future treatment of chronic pain, and I don’t often say that! One thing is for sure, after running this study, I’m not very proud of my gender.”

Story Source — Read this article on Science Daily: McGill University. “Men and women remember pain differently: Strength of finding confirmed by replication of results in mice and men.” ScienceDaily. ScienceDaily, 10 January 2019. www.sciencedaily.com/releases/2019/01/190110141806.htm.


Summit Pain Alliance pain specialists provide individualized pain management (including headaches) for a pain-free life. We believe in improving your quality of life by getting you back to doing the things that you enjoy. Our double board-certified physicians use state-of-the-art diagnostic and therapeutic techniques that exceed standards in safety and efficacy. We will be your partner on this journey. For more information and to schedule an appointment call (707) 623-9803.

Botox Injection Reduces Frequency of Migraine Headaches

A growing body of evidence supports the effectiveness of botulinum toxin injections in reducing the frequency of chronic migraine headaches, concludes an updated review and analysis in the January issue of Plastic and Reconstructive Surgery®.

Based on meta-analysis of pooled clinical trial data, botulinum toxin is superior to inactive placebo for preventive treatment of migraine, report Prof. Benoit Chaput, MD, PhD, of University Hospital Rangueil, Toulouse, France, and colleagues. “Botulinum toxin is a safe and well-tolerated treatment that should be proposed to patients with migraine,” the researchers write.

Assembled Evidence Supports Effectiveness of Botox for Chronic Migraine

Prof. Chaput and colleagues identified and analyzed data from 17 previous randomized trials comparing botulinum toxin with placebo for preventive treatment of migraine headaches. Botulinum toxin — best known by the brand name Botox — was approved by the US Food and Drug Administration (FDA) for treatment of chronic migraine in 2010. Since then, a growing number of patients have reported successful results with botulinum toxin injections to alleviate chronic migraine headaches.

The 17 studies included nearly 3,650 patients, about 1,550 of whom had chronic migraine: defined as at least 15 headache attacks per month for more than three months, with migraine symptoms on at least eight days per month. The remaining patients had less-frequent episodic migraine headaches.

On pooled data analysis, botulinum toxin injections significantly reduced the frequency of chronic migraine attacks with. Three months after injection, patients treated with botulinum toxin had an average of 1.6 fewer migraine attacks per month, compared to those treated with inactive placebo.

The improvement was apparent within two months of botulinum toxin treatment. To sustain the effects of treatment, botulinum toxin injections are typically repeated every three months.

There was also a “statistical tendency” toward less-frequent attacks with botulinum toxin in patients with episodic migraine. Again, improvement occurred within two months. Although botulinum toxin had a higher rate of adverse effects compared to placebo, none of these were serious.

The pooled data also showed significant improvement in quality of life in patients treated with botulinum toxin. This improvement was directly linked to a reduction in depressive symptoms. “It can be explained by the reduced impact of headaches and migraine-related disability, thus reducing symptoms of depression and anxiety,” Prof. Chaput and coauthors write.

Migraine headaches are an increasingly common condition, leading to significant disability and increased use of healthcare resources. Although botulinum toxin injection for chronic migraine is FDA-approved, there are still conflicting data regarding its effectiveness. The new report provides a comprehensive analysis of the highest-quality evidence to date, including three randomized trials not included in previous reports.

The results strongly support the effectiveness of botulinum toxin injection as preventive treatment for chronic migraine, with significant reductions in headache frequency at both two and three months. Prof. Chaput and colleagues add, “For the first time, our analysis highlights the significant improvement in patients’ quality of life at three months in the Botox group — which exhibited few and mild adverse events.”

Story Source – Read this article on Science Daily: Wolters Kluwer Health. “Botulinum toxin reduces chronic migraine attacks, compared to placebo.” ScienceDaily. ScienceDaily, 3 January 2019. www.sciencedaily.com/releases/2019/01/190103110722.htm.

Read more

Chronic Pain as a Symptom – Understanding CRPS

Superior Diagnosis and Treatment of Complex Regional Pain Syndrome

Are you experiencing unexplained moderate-to-severe pain and seeking to find the cause? You may have been on a long journey for a concrete diagnosis. Perhaps your physician suggested that your symptoms could possibly be due to CRPS–Complex Regional Pain Syndrome.

There are a number of conditions that have serious, chronic pain as a symptom, along with others that are also present in CRPS.  Let us show you  more about this condition and its symptoms to help you rule it in–or out.

What is CRPS?

Complex Regional Pain Syndrome is a chronic pain condition most often affecting one of the limbs (arms, legs, hands or feet), usually after an injury or trauma to that limb.  CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.  CRPS occurs when the nervous system and the immune system malfunction as they respond to tissue damage from trauma.  The nerves misfire, sending constant pain signals to the brain.  The level of pain often measures as one of the most severe. CRPS generally follows a musculoskeletal injury, a nerve injury, surgery or immobilization.  The persistent pain and disability associated with CRPS require coordinated, interdisciplinary, patient-centered care to achieve pain reduction/cessation and better function.

Early diagnosis is the key to the best outcomes.  However, diagnosing CRPS is not an easy fete and many patients search for months or years for a definitive diagnosis.

CRPS is an actual physical disorder; unfortunately, it has not been unusual for medical professionals to suggest that people with CRPS exaggerate their pain for psychological reasons.  Trust your body and continue to seek a diagnosis.  If it is in fact, complex regional pain syndrome, the pain is NOT in your mind!

Who can get CRPS?

Anyone can have CRPS.  It can strike at any age and affects both men and women, although it is much more common in women.  The average age of affected individuals is about age 40.  CRPS is rare in the elderly.  Children normally do not get it before age 5 and only rarely before age 10 but it is common in teenagers.

What are the symptoms of CRPS?

The key symptom is prolonged pain that may be constant and, in some people, extremely uncomfortable or severe.  The pain may feel like a burning or “pins and needles” sensation, or as though someone is squeezing the affected limb.  The pain can spread to include the entire arm or leg, even though the precipitating injury might have been only to a finger or toe.  Pain can sometimes even travel to the opposite extremity.  There is often increased sensitivity in the affected area, such that even light touch or contact is painful.  You can experience constant or intermittent changes in temperature, skin color, and swelling of the affected limb.  This is because of the abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature.  An affected arm or leg may feel warmer or cooler compared to the opposite limb.  The skin on the affected limb can change color, become blotch, blue, purple pale or red.  You can also encounter the following:

  • Changes in skin texture of the affected area
  • Abnormal sweating pattern in the affected area or surrounding areas
  • Changes in nail and hair growth patterns
  • Stiffness in affected joints
  • Problems coordinating muscle movement, with decreased ability to move the affected body part
  • Abnormal movement in the affected limb, most often fixed abnormal posture but also tremors in or jerking of the affected limb

How is CRPS diagnosed?

There is no single diagnostic test to confirm CRPS.  Diagnosis is based on the affected individual’s medical history and signs/symptoms that best fit the definition.  But because several other conditions can cause similar symptoms, careful examination is important.  Since most people improve gradually over time, diagnosis can be more difficult later in the course of the disorder.  The distinguishing feature of CRPS is usually a history of earlier injury to the affected area, as most of these other conditions are not triggered by injury.  Individuals without a history of injury should be carefully examined to make certain that another treatable diagnosis is not missed.  The experts will insure to take all of the necessary steps to appropriately diagnose and treat the cause of your discomfort.

How is CRPS treated?

  • Rehabilitation therapy. An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms.  Additionally, exercise can help improve the affected limb’s flexibility, strength and function.  Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain.  Occupational therapy can also offer comfort as you learn new ways to work and perform daily tasks.
  • CRPS and other painful and disabling conditions are associated with profound psychological symptoms for affected individuals and their families.  People with CRPS may develop depression, anxiety, or posttraumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.
  • Several different classes of medication have been shown to be effective for CRPS, particularly when early in the course of the disease.  Your physician can offer you an individualized treatment plan to alleviate the pain.  Drugs often used to treat CRPS include:
    • Non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen and naproxen
    • Corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
    • Drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline and duloxetine
    • Botulinum Toxin Injections
    • Opioids such as oxycontin, morphine, hydrocodone, fentanyl and vicodin
    • NMDA receptor agonists such as dextromethorphan and Ketamine
    • Nasal Calcitonin, especially for deep bone pain
    • Topical local anesthetic creams and patches such as lidocaine
  • Sympathetic nerve block. Some people report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit.  Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.
  • Surgical sympathectomy. The use of this operation that destroys some of the nerves is controversial.  Some experts think that is is unwarranted and couple make CRPS worse; others report favorable outcomes.  Sympathectomy should only be used in individuals whose pain is dramatically relieved (albeit temporarily) by sympathetic nerve blocks.  It also can reduce excess sweating.
  • Spinal Cord Stimulation. Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area.  Typically the electrode is placed temporarily for a few days to assess whether stimulation will be helpful.
  • Intrathecal drug pumps. These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids and local anesthetic agents such as clonidine and baclofen.  The advantage is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness.

What is the prognosis?

The outcome of CRPS varies from person to person.  Almost all children and teenagers have good recovery.  Some individuals are left with unremitting pain and crippling, irreversible changes despite treatment. Early treatment, particularly rehabilitation, is helpful in limiting the disorder.  We are the board-certified experts and we are sincerely committed to facilitating your pain-free life.  Take the time to discuss your symptoms with your Summit Pain Alliance Specialist and always remember to write down any questions prior to the visit. We enjoy assisting our patients to live an optimally balanced and pain-free lives.

New Study Says: To improve chronic pain, get more sleep

We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice
New research shows that chronic sleep loss increases pain sensitivity. It suggests that chronic pain sufferers can get relief by getting more sleep, or, short of that, taking medications to promote wakefulness such as caffeine.

New research from Boston Children’s Hospital and Beth Israel Deaconess Medical Center (BIDMC) shows that chronic sleep loss increases pain sensitivity. It suggests that chronic pain sufferers can get relief by getting more sleep, or, short of that, taking medications to promote wakefulness such as caffeine. Both approaches performed better than standard analgesics in a rigorous study in mice, described in the May 8, 2017 issue of Nature Medicine.

Pain physiologist Alban Latremoliere, PhD, of Boston Children’s and sleep physiologist Chloe Alexandre, PhD, of BIDMC precisely measured the effects of acute or chronic sleep loss on sleepiness and sensitivity to both painful and non-painful stimuli. They then tested standard pain medications, like ibuprofen and morphine, as well as wakefulness-promoting agents like caffeine and modafinil. Their findings reveal an unexpected role for alertness in setting pain sensitivity.

Keeping mice awake, through custom entertainment

The team started by measuring normal sleep cycles, using tiny headsets that took electroencephalography (EEG) and electromyography (EMG) readings. “For each mouse, we have exact baseline data on how much they sleep and what their sensory sensitivity is,” says Latremoliere, who works in the lab of Clifford Woolf, PhD, in the F.M. Kirby Neurobiology Center at Boston Children’s.

Next, unlike other sleep studies that force mice to stay awake walking treadmills or falling from platforms, Alexandre, Latremoliere and colleagues deprived mice of sleep in a way that mimics what happens with people: They entertained them.

“We developed a protocol to chronically sleep-deprive mice in a non-stressful manner, by providing them with toys and activities at the time they were supposed to go to sleep, thereby extending the wake period,” says Alexandre, who works in the lab of Thomas Scammell, MD, at BIDMC. “This is similar to what most of us do when we stay awake a little bit too much watching late-night TV each weekday.”

To keep the mice awake, researchers kept vigil, providing the mice with custom-made toys as interest flagged while being careful not to overstimulate them. “Mice love nesting, so when they started to get sleepy (as seen by their EEG/EMG pattern) we would give them nesting materials like a wipe or cotton ball,” says Latremoliere. “Rodents also like chewing, so we introduced a lot of activities based around chewing, for example, having to chew through something to get to a cotton ball.”

In this way, they kept groups of six to 12 mice awake for as long as 12 hours in one session, or six hours for five consecutive days, monitoring sleepiness and stress hormones (to make sure they weren’t stressed) and testing for pain along the way.

Pain sensitivity was measured in a blinded fashion by exposing mice to controlled amounts of heat, cold, pressure or capsaicin (the agent in hot chili peppers) and then measuring how long it took the animal to move away (or lick away the discomfort caused by capsaicin). The researchers also tested responses to non-painful stimuli, such as jumping when startled by a sudden loud sound.

“We found that five consecutive days of moderate sleep deprivation can significantly exacerbate pain sensitivity over time in otherwise healthy mice,” says Alexandre. “The response was specific to pain, and was not due to a state of general hyperexcitability to any stimuli.”

Analgesics vs. wake-promoting agents

Surprisingly, common analgesics like ibuprofen did not block sleep-loss-induced pain hypersensitivity. Even morphine lost most of its efficacy in sleep-deprived mice. These observations suggest that patients using these drugs for pain relief might have to increase their dose to compensate for lost efficacy due to sleep loss, thereby increasing their risk for side effects.

In contrast, both caffeine and modafinil, drugs used to promote wakefulness, successfully blocked the pain hypersensitivity caused by both acute and chronic sleep loss. Interestingly, in non-sleep-deprived mice, these compounds had no analgesic properties.

“This represents a new kind of analgesic that hadn’t been considered before, one that depends on the biological state of the animal,” says Woolf, director of the Kirby Center at Boston Children’s. “Such drugs could help disrupt the chronic pain cycle, in which pain disrupts sleep, which then promotes pain, which further disrupts sleep.”

A new approach to chronic pain?

The researchers conclude that rather than just taking painkillers, patients with chronic pain might benefit from better sleep habits or sleep-promoting medications at night, coupled with daytime alertness-promoting agents to try to break the pain cycle. Some painkillers already include caffeine as an ingredient, although its mechanism of action isn’t yet known. Both caffeine and modafinil boost dopamine circuits in the brain, so that may provide a clue.

“This work was supported by a novel NIH program that required a pain scientist to join a non-pain scientist to tackle a completely new area of research,” notes Scammel, professor of neurology at BIDMC. “This cross-disciplinary collaboration enabled our labs to discover unsuspected links between sleep and pain with actionable clinical implications for improving pain management.”

“Many patients with chronic pain suffer from poor sleep and daytime fatigue, and some pain medications themselves can contribute to these co-morbidities,” notes Kiran Maski, MD, a specialist in sleep disorders at Boston Children’s. “This study suggests a novel approach to pain management that would be relatively easy to implement in clinical care. Clinical research is needed to understand what sleep duration is required and to test the efficacy of wake-promoting medications in chronic pain patients.”


Story Source:

Materials provided by Boston Children’s Hospital. Note: Content may be edited for style and length.


Journal Reference:

  1. Chloe Alexandre, Alban Latremoliere, Ashley Ferreira, Giulia Miracca, Mihoko Yamamoto, Thomas E Scammell, Clifford J Woolf. Decreased alertness due to sleep loss increases pain sensitivity in mice. Nature Medicine, 2017; DOI: 10.1038/nm.4329

Read this article on Science Daily: Boston Children’s Hospital. “To improve chronic pain, get more sleep (coffee helps too): In sleep-deprived mice, caffeine and other drugs to promote wakefulness ease pain better than analgesics.” ScienceDaily. ScienceDaily, 8 May 2017. www.sciencedaily.com/releases/2017/05/170508112447.htm.

Touch-based Interventions Alleviates Pain in Babies

Researchers found that gently stroking a baby seems to reduce activity in the infant brain associated with painful experiences. Their results, appearing December 17 in the journal Current Biology, suggest that lightly brushing an infant at a certain speed — of approximately 3 centimeters per second — could provide effective pain relief before clinically necessary medical procedures.

“Parents intuitively stroke their babies at this optimal velocity,” says senior author Rebeccah Slater, professor of pediatric science at the University of Oxford, who worked alongside collaborators from Liverpool John Moores University. “If we can better understand the neurobiological underpinnings of techniques like infant massage, we can improve the advice we give to parents on how to comfort their babies.”

Slater and her team measured newborns’ pain responses to medically necessary blood tests by observing their behavior and detecting their brain activity using electroencephalography (EEG), a technique that measures tiny bursts of electrical activity from the surface of the brain. For half of the babies, a scientist on Slater’s team stroked their skin gently with a soft brush right before the blood test.

Slater’s previous work showed that EEG activity increases in the infant brain immediately after a blood test. This pattern of pain-related activity can be lowered by interventions, such as the application of a local anesthetic prior to the procedure. In her most recent experiment, she found that the babies who received light stroking touch showed lower pain-related EEG activity. However, the babies still reflexed their limbs away from the stimulus.

“We hypothesized that stroking would reduce pain-related brain activity, so we were pleased to see it. But we didn’t see a reduction in how they reflex their limbs away from the heel lance,” says Slater. “That could mean our intervention is perhaps causing a dissociation between limb movement and brain activity.”

The optimal pain-reducing stroking speed of approximately 3 centimeters per second is the same frequency that activates a class of sensory neurons in the skin called C-tactile afferents, which have been previously been shown to reduce pain in adults. Up until now, it was unclear whether this sensory response occurred in newborns or developed over time.

“There was evidence to suggest that C-tactile afferents can be activated in babies and that slow, gentle touch can evoke changes in brain activity in infants,” says Slater.

Slater says that the pain-reducing power of stroking appears to be clinically useful, and it could explain anecdotal evidence of the soothing power of touch-based interventions such as infant massage and kangaroo care — the practice of holding premature babies against the skin to encourage parent-infant bonding and possibly reduce pain. Slater and her group plan to repeat their experiment in premature babies, whose sensory pathways are still developing.

“Previous work has shown that touch may increase parental bonding, decrease stress for both the parents and the baby, and reduce the length of hospital stay,” says Slater. “Touch seems to have analgesic potential without the risk of side effects.”

Story Source — Read this article on Science Daily: Cell Press. “Gently stroking babies before medical procedures may reduce pain processing.” ScienceDaily. ScienceDaily, 17 December 2018. www.sciencedaily.com/releases/2018/12/181217125906.htm.


Summit Pain Alliance pain specialists provide individualized pain management (including Pelvic Pain) for a pain-free life. We believe in improving your quality of life by getting you back to doing the things that you enjoy. Our double board-certified physicians use state-of-the-art diagnostic and therapeutic techniques that exceed standards in safety and efficacy. We will be your partner on this journey. For more information and to schedule an appointment call (707) 623-9803.

New study reveals pulsed radiofrequency helpful for acute back pain and sciatica


Probe being applied to nerve root.

Credit: Radiological Society of North America

A minimally invasive procedure in which pulses of energy from a probe are applied directly to nerve roots near the spine is safe and effective in people with acute lower back pain that has not responded to conservative treatment, according to a study being presented today at the annual meeting of the Radiological Society of North America (RSNA).

Lumbar disk herniation is a common, often debilitating, condition that affects the disks that act as cushions between the vertebrae of the lower spine. Herniation occurs where the jelly-like material in the center of the disk bulges through a tear in the disk’s tough exterior layer and puts pressure on the roots of the nerves. Herniated disks are often the source of sciatica, or pain that radiates downward from the lower back into the leg.Conservative treatment options for herniated disks range from over-the-counter pain medications to injections of corticosteroids directly into the affected area of the spine.

Those who don’t respond may require surgery. In some cases, the entire disk must be removed and the vertebra fused together for stability. An alternative technique, CT-guided pulsed radiofrequency (pRF), applies energy through an electrode under CT guidance to the portion of the nerve responsible for sending pain signals. “Pulsed radiofrequency creates a nerve modulation, significantly reducing inflammation and its associated symptoms,” said study senior author Alessandro Napoli, M.D., Ph.D., professor of interventional radiology at Sapienza University of Rome in Italy.

Dr. Napoli and colleagues studied the approach in patients with back pain from lumbar disk herniation that had not responded to prolonged conservative treatment. In 128 patients, the pRF treatment was delivered directly under CT guidance to the root of the nerve. The treatment was applied for 10 minutes.For comparison, a group of 120 patients received one to three sessions of CT-guided steroid injection on the same anatomical target with no pRF.The one-year outcomes demonstrated that CT-guided pRF was superior to the injection-only strategy. Patients who received pRF saw greater overall improvement in pain and disability scores during the first year.

Relief of leg pain was faster in patients assigned to pRF, and they also reported a faster rate of perceived recovery. The probability of perceived recovery after one year of follow-up was 95 percent in the pRF group, compared with 61 percent in the injection only group.”Given our study results, we offer pulsed radiofrequency to patients with herniated disk and sciatic nerve compression whose symptoms do not benefit from conservative therapy,” Dr. Napoli said.

The results of the study are superior to those typically reported for usual care strategies and injections and may help a substantial number of patients with sciatic disk compression to avoid surgery, Dr. Napoli added. The use of pRF also could improve outcomes for patients set to receive corticosteroid injections.”We learned that when pulsed radiofrequency is followed by steroid injection, the result is longer lasting and more efficacious than injection only,” Dr. Napoli said. “The effect of pulsed radiofrequency is fast and without adverse events. “Today, therapy for spine disorders allows for definitive treatment of symptoms and conditions using different techniques and technologies.”

Of the different therapies available, pulsed radiofrequency is among the least invasive,” Dr. Napoli said. “Treatment lasts 10 minutes, and one session was enough in a large number of treated patients.”Co-authors are Roberto Scipione, M.D., Fabrizio Andrani, M.D., Susan Dababou, Cristina Marrocchio, Michele Anzidei, M.D., and Carlo Catalano, M.D.


Story Source: Read this article on Science Daily: Radiological Society of North America. “Pulsed radiofrequency relieves acute back pain and sciatica.” ScienceDaily. ScienceDaily, 27 November 2018. www.sciencedaily.com/releases/2018/11/181127092604.htm.


Summit Pain Alliance pain specialists provide individualized pain management (including Pelvic Pain) for a pain-free life. We believe in improving your quality of life by getting you back to doing the things that you enjoy. Our double board-certified physicians use state-of-the-art diagnostic and therapeutic techniques that exceed standards in safety and efficacy. We will be your partner on this journey. For more information and to schedule an appointment call (707) 623-9803.

Brain imaging research shows that when we expect something to hurt it does

Fear of pain

Expect a shot to hurt and it probably will, even if the needle poke isn’t really so painful. Brace for a second shot and you’ll likely flinch again, even though — second time around — you should know better.

That’s the takeaway of a new brain imaging study published in the journal Nature Human Behaviour which found that expectations about pain intensity can become self-fulfilling prophecies. Surprisingly, those false expectations can persist even when reality repeatedly demonstrates otherwise, the study found.

“We discovered that there is a positive feedback loop between expectation and pain,” said senior author Tor Wager, a professor of psychology and neuroscience at the University of Colorado Boulder. “The more pain you expect, the stronger your brain responds to the pain. The stronger your brain responds to the pain, the more you expect.”

For decades, researchers have been intrigued with the idea of self-fulfilling prophecy, with studies showing expectations can influence everything from how one performs on a test to how one responds to a medication. The new study is the first to directly model the dynamics of the feedback loop between expectations and pain and the neural mechanisms underlying it.

Marieke Jepma, then a postdoctoral researcher in Wager’s lab, launched the research after noticing that even when test subjects were shown time and again that something wouldn’t hurt badly, some still expected it to.

“We wanted to get a better understanding of why pain expectations are so resistant to change,” said Jepma, lead author and now a researcher at the University of Amsterdam.

The researchers recruited 34 subjects and taught them to associate one symbol with low heat and another with high, painful heat.

Then, the subjects were placed in a functional magnetic resonance imaging (fMRI) machine, which measures blood flow in the brain as a proxy for neural activity. For 60 minutes, subjects were shown low or high pain cues (the symbols, the words Low or High, or the letters L and W), then asked to rate how much pain they expected.

Then varying degrees of painful but non-damaging heat were applied to their forearm or leg, with the hottest reaching “about what it feels like to hold a hot cup of coffee” Wager explains.

Then they were asked to rate their pain.

Unbeknownst to the subjects, heat intensity was not actually related to the preceding cue.

The study found that when subjects expected more heat, brain regions involved in threat and fear were more activated as they waited. Regions involved in the generation of pain were more active when they received the stimulus. Participants reported more pain with high-pain cues, regardless of how much heat they actually got.

“This suggests that expectations had a rather deep effect, influencing how the brain processes pain,” said Jepma.

Surprisingly, their expectations also highly influenced their ability to learn from experience. Many subjects demonstrated high “confirmation bias” — the tendency to learn from things that reinforce our beliefs and discount those that don’t. For instance, if they expected high pain and got it, they might expect even more pain the next time. But if they expected high pain and didn’t get it, nothing changed.

“You would assume that if you expected high pain and got very little you would know better the next time. But interestingly, they failed to learn,” said Wager.

This phenomenon could have tangible impacts on recovery from painful conditions, suggests Jepma.

“Our results suggest that negative expectations about pain or treatment outcomes may in some situations interfere with optimal recovery, both by enhancing perceived pain and by preventing people from noticing that they are getting better,” she said. “Positive expectations, on the other hand, could have the opposite effects.”

The research also may shed light on why, for some, chronic pain can linger long after damaged tissues have healed.

Whether in the context of pain or mental health, the authors suggest that it may do us good to be aware of our inherent eagerness to confirm our expectations.

“Just realizing that things may not be as bad as you think may help you to revise your expectation and, in doing so, alter your experience,” said Jepma.


Story Source: Read this article on Science Daily: University of Colorado at Boulder. “Pain can be a self-fulfilling prophecy: New brain imaging research shows that when we expect something to hurt it does, even if the stimulus isn’t so painful.” ScienceDaily. ScienceDaily, 13 November 2018. www.sciencedaily.com/releases/2018/11/181113171338.htm.

Canadian study on truck drivers seeks to alleviate musculoskeletal (MSD) pain risks

Almost 60 per cent of truck drivers in a recent study reported experiencing musculoskeletal (MSD) pain and discomfort on the job, even though it may be preventable. “Given the fact that MSDs account for nearly one-half of all work-related illnesses and the transportation sector makes up a significant portion of that, understanding the risk factors associated with musculoskeletal disorders is important,” said lead author Sonja Senthanar, a doctoral candidate in the School of Public Health and Health Systems. “While the link between trucking and MSDs has been studied in other countries, there is a dearth of research in Canada.”

According to the Ontario Ministry of Transportation, truck driving is the second most common occupation in Canada, employing nearly one in 35 males between the ages of 20 and 64 years while the American Trucking Associations estimates that there are 3.5 million truck drivers in the USA.

Public health researchers at the University of Waterloo surveyed 107 male truck drivers passing through two popular highway stops in Southern Ontario and found that 57 per cent had experienced musculoskeletal pain and discomfort, especially low back pain. They found an association between this pain and discomfort and specific risk factors, including organizational safety climate, level of risk associated with the job, exhaustion from work tasks, being married and having higher education levels.

Senthanar said that being married and more educated are presumably associated with pain and discomfort because the presence of a spouse and knowledge gained from education can increase awareness of musculoskeletal symptoms — and therefore rates of reporting.

Co-author Philip Bigelow, a professor in the School of Public Health and Health Systems, said, “Physical exposures such as awkward postures, repetition, lifting, whole body vibration and prolonged sitting, as well as personal factors such as physical fitness and job satisfaction, are known to be associated with the development of MSDs. Since driving a truck involves a variety of these risk factors, programs that address these multiple factors are needed.”

Bigelow said that a number of large Canadian carriers have adopted programs that take holistic approaches that include reducing vibration exposures through improved seating, modifying workloads and physical tasks, as well as promoting the overall wellness of drivers by encouraging physical activity and healthy eating.

Researchers at the University of Waterloo are members of a Canadian team of researchers that is engaged with stakeholders in the industry to identify such wholistic programs and to evaluate their impacts. They hope that companies with successful programs can act as champions of driver health and wellness to improve working conditions for all truck drivers.


Story Source: Read this article on Science Daily: University of Waterloo. “Truck driver pain and discomfort can be alleviated.” ScienceDaily. ScienceDaily, 29 October 2018. www.sciencedaily.com/releases/2018/10/181029150925.htm.


 

Women who suffer from chronic back pain at increased risk of death

Researchers at Boston Medical Center found that frequent, persistent back pain is associated with earlier death in a study of more than 8,000 older women who were followed for an average of 14 years. After controlling for important sociodemographic and health factors, women who reported frequent, persistent back pain had a 24 percent increased risk of death compared to women with no back pain. Published in the Journal of General Internal Medicine, the study is the first to measure the impact of back pain persisting over time on mortality. The researchers also found that disability measured after back pain helped explain the association.

Back pain is the leading cause of disability worldwide, and women aged 40-80 years have the highest prevalence of back pain. Also, women report more frequent and debilitating back pain compared to men. The proportion of adults over the age of 65 is increasing rapidly in the United States, and optimizing physical health in order to extend life for older adults is a well-documented public health goal.

“To our knowledge, our study is the first to measure disability after measurement of back pain. This allowed for a prospective analysis of back pain that persisted over time and later rates of disability, which may help explain the association between back pain and mortality,” said Eric Roseen, DC, MSc, a research fellow at Boston Medical Center and leading author of the study. “Our findings raise the question of whether better management of back pain across the lifespan could prevent disability, improve quality of life, and ultimately extend life.”

After taking baseline measurements of back pain, researchers followed up with participants two years later and measured back pain again. In year four, participants were asked about and observed doing common activities of daily living. The study found that disability following the measurements of back pain explained much of the association with mortality.

Specifically, difficulty performing one or more basic daily activities, like walking short distances or meal preparation, explained nearly half (47 percent) of the effect of frequent persistent back pain on mortality. Slow performance on more objective measures, like observed walking speed or repetitive standing up from a chair, each explained about a fourth of this association (27 percent and 24 percent, respectively). Of 8,321 women in the study, 56 percent died over a median follow up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8 percent) than those with no back pain (53.5 percent).

While the study’s findings are consistent with prior studies that found older women with daily or disabling back pain had elevated mortality risk, why this association occurs remains unclear.

“Back pain may directly impair daily activities, but older adults could inappropriately avoid them due to fear of re-injury or worsening of symptoms. Being unable to perform, or avoiding, daily activities could lead to weight gain, development or progression of other chronic health conditions, and ultimately earlier death,” said Roseen.

These results lay the foundation for future studies to assess the long-term impact of back pain treatments and self-care strategies. Clinicians should assess physical function in older adults with back pain and recommend guideline-based management, which encourages use of less invasive treatments.

Story Source — Read this article on Science Daily: Boston Medical Center. “Back pain shows significant association with mortality among older women.” ScienceDaily. ScienceDaily, 6 November 2018. www.sciencedaily.com/releases/2018/11/181106111619.htm.


At Summit Pain Alliance, we believe in improving your quality of life by getting you back to doing the things that you enjoy. Our double board-certified physicians use state-of-the-art diagnostic and therapeutic techniques that exceed standards in safety and efficacy. We will be your partner on this journey. Summit Pain Alliance pain specialists provide individualized pain management for a pain-free life. For more information and to schedule an appointment call (707) 623-9803 or visit summitpainalliance.com.

Learn more about back pain and treatment options here  —>

Long-term relief for back pain via pain disruption therapy

 

People with treatment-resistant back pain may get significant and lasting relief with dorsal root ganglion (DRG) stimulation therapy, an innovative treatment that short-circuits pain, suggests a study presented at the ANESTHESIOLOGY® 2018 annual meeting.

Chronic pain — pain that lasts three months or more — occurs when nerves continue to send signals to the brain after the original source of the pain is gone. An alternative to spinal cord stimulation, DRG stimulation disrupts pain signals by specifically targeting the nerves responsible for the pain. This may avoid unnecessary stimulation of nerve fibers that come from non-painful areas, which may occur with spinal cord stimulation. It also helps to meet the need for non-drug pain treatments in select patients.

“People in our study who had DRG stimulation reported significant improvement in pain even after a year, which is notable,” said Robert J. McCarthy, Pharm.D., lead author of the study and professor of anesthesiology at Rush University Medical Center, Chicago. “They had tried numerous therapies, from drugs to spinal cord stimulation to surgery, but got little to no lasting pain relief. For most, DRG stimulation really improved their quality of life.”

A cluster of neurons located on both sides of each vertebra, the DRG serves as the pain and sensation gateway between nerves in different parts of the body and the spinal cord and brain. DRG stimulation therapy interrupts the pain signal between the painful area and the brain. A pacemaker-like device implanted under the skin in the lower back sends small electronic pulses through a wire placed near the DRG that is connected to the nerve associated with the pain. The pulses replace the pain with another more tolerable sensation, such as tingling or numbness. The level of current provided by the device is programmed by a physician anesthesiologist or other pain specialist based on the patient’s pain.

DRG stimulation offers two advantages over spinal cord stimulation. For the latter, a wire is placed along the spinal cord so the electronic pulses are sent along the spine, but don’t target the specific pain source as DRG stimulation does. Additionally, lower levels of current are required to achieve benefit with DRG stimulation because there is less spinal fluid covering the DRG than the spinal cord.

In the study, researchers implanted DRG stimulation devices in 67 people with chronic back pain. Patients were followed for 3 to 18 months. Seventeen patients had the device for more than a year. The study found:

  • Before implantation of the DRG device, most participants described their pain as 8 on a scale of 1 to 10 (with 10 being the worst pain imaginable). After follow-up, the median (most common) pain score fell to 5, a decrease of 33 percent, which the authors note is a clinically significant improvement.
  • Patients reported a 27 percent decrease (median) in disability, or patient-reported limitations to daily living, due to pain.
  • 94 percent of patients reported the treatment was beneficial.
  • Five patients (7.4 percent) had to have the wires re-implanted, 2 (3 percent) had them removed after they were infected and 1 had the device removed due to a complication.

“There is a real need for non-drug therapy relief for people with chronic pain,” said Dr. McCarthy. “Although it is more technically difficult to place the electrodes, it may be an option for patients who haven’t benefited from other pain therapies, and may reduce or eliminate the need for opioids.”

Story Source — Read this article on Science Daily: American Society of Anesthesiologists. “Pain disruption therapy treats source of chronic back pain: Dorsal root ganglion stimulation provides long-term relief, research shows.” ScienceDaily. ScienceDaily, 14 October 2018. www.sciencedaily.com/releases/2018/10/181014183311.htm.

Call Now
Directions