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Researchers move closer to blood test for fibromyalgia

For the first time, researchers have evidence that fibromyalgia can be reliably detected in blood samples – work they hope will pave the way for a simple, fast diagnosis.

In a study that appears in the Journal of Biological Chemistry, researchers from The Ohio State University report success in identifying biomarkers of fibromyalgia and differentiating it from a handful of other related diseases.

The discovery could be an important turning point in care of patients with a disease that is frequently misdiagnosed or undiagnosed, leaving them without proper care and advice on managing their chronic pain and fatigue, said lead researcher Kevin Hackshaw, a professor in Ohio State’s College of Medicine and a rheumatologist at the university’s Wexner Medical Center.

Identification of biomarkers of the disease – a “metabolic fingerprint” like that discovered in the new study – could also open up the possibility of targeted treatments, he said.

To diagnose fibromyalgia, doctors now rely on patient-reported information about a multitude of symptoms and a physical evaluation of a patient’s pain, focusing on specific tender points, he said. But there’s no blood test – no clear-cut, easy-to-use tool to provide a quick answer.

“We found clear, reproducible metabolic patterns in the blood of dozens of patients with fibromyalgia. This brings us much closer to a blood test than we have ever been,” Hackshaw said.

Though fibromyalgia is currently incurable and treatment is limited to exercise, education and antidepressants, an accurate diagnosis has many benefits, Hackshaw said. Those include ruling out other diseases, confirming for patients that their symptoms are real and not imagined, and guiding doctors toward disease recognition and appropriate treatment.

“Most physicians nowadays don’t question whether fibromyalgia is real, but there are still skeptics out there,” Hackshaw said.

And many undiagnosed patients are prescribed opioids – strong, addictive painkillers that have not been shown to benefit people with the disease, he said.

“When you look at chronic pain clinics, about 40 percent of patients on opioids meet the diagnostic criteria for fibromyalgia. Fibromyalgia often gets worse, and certainly doesn’t get better, with opioids.”

Hackshaw and co-author Luis Rodriguez-Saona, an expert in the advanced testing method used in the study, said the next step is a larger-scale clinical trial to determine if the success they saw in this research can be replicated.

The current study included 50 people with a fibromyalgia diagnosis, 29 with rheumatoid arthritis, 19 who have osteoarthritis and 23 with lupus.

Researchers examined blood samples from each participant using a technique called vibrational spectroscopy, which measures the energy level of molecules within the sample. Scientists in Rodriguez-Saona’s lab detected clear patterns that consistently set fibromyalgia patients’ blood sample results apart from those with other, similar disorders.

First, the researchers analyzed blood samples from participants whose disease status they knew, so they could develop a baseline pattern for each diagnosis. Then, using two types of spectroscopy, they evaluated the rest of the samples blindly, without knowing the participants’ diagnoses, and accurately clustered every study participant into the appropriate disease category based on a molecular signature.

“These initial results are remarkable. If we can help speed diagnosis for these patients, their treatment will be better and they’ll likely have better outlooks. There’s nothing worse than being in a gray area where you don’t know what disease you have,” Rodriguez-Saona said.

His lab mostly concerns itself with using the metabolic fingerprinting technology for food-related research, focusing on issues such as adulteration of milk and cooking oils and helping agriculture companies figure out which plants are best suited to fight disease.

The chance to partner with medical experts to help solve the problem of fibromyalgia misdiagnosis was exciting, said Rodriguez-Saona, a professor of food science and technology at Ohio State.

Rodriguez-Saona said for the next study he’d like to examine 150 to 200 subjects per disease group to see if the findings of this research are replicable in a larger, more-diverse population.

Hackshaw said his goal is to have a test ready for widespread use within five years.

Fibromyalgia is the most common cause of chronic widespread pain in the United States, and disproportionately affects women. The U.S. Centers for Disease Control and Prevention estimates that about 2 percent of the population – around 4 million adults – has fibromyalgia. Other organizations estimate even higher numbers.

About three in four people with fibromyalgia have not received an accurate diagnosis, according to previous research, and those who do know they have the disease waited an average of five years between symptom onset and diagnosis. Common symptoms include pain and stiffness all over the body, fatigue, depression, anxiety, sleep problems, headaches and problems with thinking, memory and concentration.

Eventually, this work could lead to identification of a particular protein or acid – or combination of molecules – that is linked to fibromyalgia, Rodriguez-Saona said.

“We can look back into some of these fingerprints and potentially identify some of the chemicals associated with the differences we are seeing,” he said.

In addition to identifying fibromyalgia, the researchers also found evidence that the metabolic fingerprinting technique has the potential to determine the severity of fibromyalgia in an individual patient.

“This could lead to better, more directed treatment for patients,” Hackshaw said.

Story Source: Read this article on Science Daily — Ohio State University. “Experimental blood test accurately spots fibromyalgia: Study finds unique ‘molecular signature’ for often-misdiagnosed disease.” ScienceDaily. ScienceDaily, 18 March 2019. www.sciencedaily.com/releases/2019/03/190318084127.htm.


Summit Pain Alliance pain specialists provide individualized pain management 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.

Study explores alcohol consumption as migraine trigger

In a European Journal of Neurology study of 2,197 patients who experience migraines, alcoholic beverages were reported as a trigger by 35.6 percent of participants.

Additionally, more than 25 percent of migraine patients who had stopped consuming or never consumed alcoholic beverages did so because of presumed trigger effects. Wine, especially red wine (77.8 percent of participants), was recognized as the most common trigger among the alcoholic beverages; however, red wine consistently led to an attack in only 8.8 percent of participants. Time of onset was rapid (less than three hours) in one third of patients, and almost 90 percent of patients had an onset in under 10 hours independent of the type of alcoholic beverage consumed.

The authors noted that it can be debated if alcohol is a factual or a presumed trigger. Additional studies are needed to unravel this relationship.

“Alcohol-triggered migraine occurs rapidly after intake of alcoholic beverages, suggesting a different mechanism than a normal hangover,” said senior author Dr. Gisela Terwindt, of the Leiden University Medical Center, in the Netherlands.

Story Source — Read this article on Science Daily: Wiley. “Alcoholic beverages are frequently considered migraine triggers.” ScienceDaily. ScienceDaily, 19 December 2018. www.sciencedaily.com/releases/2018/12/181219075841.htm.


Summit Pain Alliance pain specialists provide individualized pain management 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.

Acupuncture, mindfulness, massage may decrease pain

A new study, published Feb. 20, 2019, in the Journal of General Internal Medicine, tracked the impact of a program for low-income, at-risk patients with chronic pain at Tom Waddell Urban Health Clinic, in San Francisco’s Tenderloin neighborhood, a public health facility where UCSF medical students are trained and mentored.

The program offered group support, acupuncture, mindfulness, massage and gentle exercise to help prevent patients on prescription opioids from spiraling down to drug misuse, overdose and death, according to a study led by researchers at UCSF.

“Opioids are often prescribed to patients with moderate-to-severe pain from chronic health conditions, or for pain following injury or surgery,” said first author Maria T. Chao, DrPH, MPA, of the UCSF Osher Center for Integrative Medicine. “Because of the potential dangers of opioid use, we wanted to see if a multimodal, non-pharmacological program could decrease pain levels and stabilize prescription opioid use in vulnerable patients with high rates of pain and barriers to care.”

The study compared 41 participants who had been on prescription drugs such as hydrocodone, oxycodone and methadone for at least three months with 20 other would-be participants who expressed interest in the program. The researchers found a 12 percent drop in pain intensity in the study participants, compared with no change in pain among the comparison group.

The most notable improvement was a 22 percent boost in “pain self-efficacy,” a patient’s ability to manage and function in their daily life despite their pain, said Chao, who also works at Zuckerberg San Francisco General Hospital and Trauma Center. This compares with a decline among the control group.

After completion of the three-month program, patients continued to have access to weekly groups offering the same services. Opioid prescription use remained consistent during the program and dipped slightly three months later.

“We’re not claiming the program is a panacea to the opioid crisis,” said Chao. “We’re trying to broaden treatment options for safe pain management. Doctors, especially in primary care, are under tremendous pressure to taper opioids, but they have a limited toolbox of options to alleviate their patients’ pain.”

National drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017, according to the Centers for Disease Control and Prevention. This compares to 15,482 overdose deaths in 2017 involving heroin.

“The framework for treatment of chronic pain is a biopsychosocial model,” said senior author Barbara Wismer, MD, MPH, previously of the San Francisco Department of Public Health and the UCSF Department of Family and Community Medicine “This posits there are physical factors that lead to chronic pain, such as tissue injury, but the patient’s psychosocial state, such as thoughts, emotions and behavior contribute greatly.”

Characteristics of the 41 participants included disability (76 percent), unstable, transitional or room-rental accommodation (46 percent) and post-traumatic stress disorder (37 percent). All 41 had an annual income of less than $35,000 and many reported risks of “problematic substance use” that caused health, financial, legal or social problems.

“Treatments such as acupuncture and massage are not always available to those of lesser means,” said Chao. “We found that patients with complex lives and limited income can really benefit from this integrative approach. We are very committed to broadening these types of treatment options for all.”

Co-Authors: Emily Hurstak, MD, MPH, MAS, of UCSF; Kristina Leonoudakis-Watts, Frank Sidders and Joseph Pace, MD, of the San Francisco Department of Public Health; and Hali Hammer, MD, of UCSF and the San Francisco Department of Public Health.

Story Source: Read this article on Science Daily — University of California – San Francisco. “Peer support, healing hands may curb prescription opioid misuse: Study shows holistic approach may help prevent drug deaths in vulnerable populations.” ScienceDaily. ScienceDaily, 20 February 2019. www.sciencedaily.com/releases/2019/02/190220133629.htm.

New blood test may help physicians treat pain better

A breakthrough test developed by Indiana University School of Medicine researchers to measure pain in patients could help stem the tide of the opioid crisis in Indiana, and throughout the rest of the nation.

A study led by psychiatry professor Alexander Niculescu, MD, PhD and published this week in the Nature journal Molecular Psychiatry tracked hundreds of participants at the Richard L. Roudebush VA Medical Center in Indianapolis to identify biomarkers in the blood that can help objectively determine how severe a patient’s pain is. The blood test, the first of its kind, would allow physicians far more accuracy in treating pain — as well as a better long-term look at the patient’s medical future.

“We have developed a prototype for a blood test that can objectively tell doctors if the patient is in pain, and how severe that pain is. It’s very important to have an objective measure of pain, as pain is a subjective sensation. Until now we have had to rely on patients self-reporting or the clinical impression the doctor has,” said Niculescu, who worked with other Department of Psychiatry researchers on the study. “When we started this work it was a farfetched idea. But the idea was to find a way to treat and prescribe things more appropriately to people who are in pain.”

During the study, researchers looked at biomarkers found in the blood — in this case molecules that reflect disease severity. Much like as glucose serves as a biomarker to diabetes, these biomarkers allow doctors to assess the severity of the pain the patient is experiencing, and provide treatment in an objective, quantifiable manner. With an opioid epidemic raging throughout the state and beyond, Niculescu said never has there been a more important time to administer drugs to patients responsibly.

“The opioid epidemic occurred because addictive medications were overprescribed due to the fact that there was no objective measure whether someone was in pain, or how severe their pain was,” Niculescu said. “Before, doctors weren’t being taught good alternatives. The thought was that this person says they are in pain, let’s prescribe it. Now people are seeing that this created a huge problem. We need alternatives to opioids, and we need to treat people in a precise fashion. This test we’ve developed allows for that.”

In addition to providing an objective measure of pain, Niculescu’s blood test helps physicians match the biomarkers in the patient’s blood with potential treatment options. Like a scene out of CSI, researchers utilize a prescription database — similar to fingerprint databases employed by the FBI — to match the pain biomarkers with profiles of drugs and natural compounds cataloged in the database.

“The biomarker is like a fingerprint, and we match it against this database and see which compound would normalize the signature,” said Niculescu, adding that often the best treatment identified is a non-opioid drug or compound. “We found some compounds that have been used for decades to treat other things pair the best with the biomarkers. We have been able to match biomarkers with existing medications, or natural compounds, which would reduce or eliminate the need to use the opioids.”

In keeping with the IU Grand Challenge Precision Health Initiative launched in June 2016, this study opens the door to precision medicine for pain. By treating and prescribing medicine more appropriately to the individual person, this prototype may help alleviate the dilemmas that have contributed to the current opioid epidemic.

“In any field, the goal is to match the patient to the right drug, which hopefully does a lot of good and very little harm,” Niculescu said. “But through precision health, by having lots of options geared toward the needs of specific patients, you prevent larger problems, like the opioid epidemic, from occurring.”

Additionally, study experts discovered biomarkers that not only match with non-addictive drugs that can treat pain, but can also help predict when someone might experience pain in the future — helping to determine if a patient is exhibiting chronic, long-term pain which might result in future emergency room visits.

“Through precision medicine you’re giving the patient treatment that is tailored directly to them and their needs,” Niculescu said. “We wanted first to find some markers for pain that are universal, and we were able to. We know, however, based on our data that there are some markers that work better for men, some that work better for women. It could be that there are some markers that work better for headaches, some markers that work better for fibromyalgia and so on. That is where we hope to go with future larger studies.”

The study was supported by an NIH Director’s New Innovator Award and a VA Merit Award. Moving forward, Niculescu’s group looks to secure more funding through grants or outside philanthropy to continue and accelerate these studies — with the hopes of personalizing the approach even more and moving toward a clinical application. A self-described longshot at the start, Niculescu said that the work his group has done could have a major impact on how doctors around the world treat pain in the future.

“It’s been a goal of many researchers and a dream to find biomarkers for pain,” Niculescu said. “We have come out of left field with an approach that had worked well in psychiatry for suicide and depression in previous studies. We applied it to pain, and we were successful. I give a lot of credit for that to my team at IU School of Medicine and the Indianapolis VA, as well as the excellent environment and support we have.”


Story Source — Read this article on Science Daily:  Indiana University. “Breakthrough toward developing blood test for pain.” ScienceDaily. ScienceDaily, 13 February 2019. www.sciencedaily.com/releases/2019/02/190213142715.htm.


Summit Pain Alliance pain specialists provide individualized pain management 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.

Poor sleep at night leads to increased pain the next day

Frustrated tired young African-American employee touching his head, feeling absolutely exhausted because of overwork, calculating accounts, drinking another cup of coffee. Deadline and overwork

After one night of inadequate sleep, brain activity ramps up in pain-sensing regions while activity is scaled back in areas responsible for modulating how we perceive painful stimuli. This finding, published in JNeurosci, provides the first brain-based explanation for the well-established relationship between sleep and pain.

In two studies — one in a sleep laboratory and the other online — Matthew Walker and colleagues show how the brain processes pain differently when individuals are sleep deprived and how self-reported sleep quality and pain sensitivity can change night-to-night and day-to-day. When the researchers kept healthy young adults awake through the night in the lab, they observed increased activity in the primary somatosensory cortex and reduced activity in regions of the striatum and insula cortex during a pain sensitivity task. Participants in the online study, recruited via the crowdsourcing marketplace Amazon Mechanical Turk, reported increased pain during the day after reporting poor sleep the night before.

These results suggest improving sleep quality, especially in hospital settings, could be an effective approach for pain management. More generally, the research highlights the interrelationship between sleep and pain, which is decreasing and increasing, respectively, in societies around the world.

Story Source: Read this article on Science Daily — Society for Neuroscience. “Poor sleep at night, more pain the next day.” ScienceDaily. ScienceDaily, 29 January 2019. www.sciencedaily.com/releases/2019/01/190129093714.htm.

Materials provided by Society for Neuroscience. Note: Content may be edited for style and length.


Summit Pain Alliance pain specialists provide individualized pain management 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.

Chronic Pain Most Common Reason for Medical Cannabis Use

Slowly but surely, the stigma surrounding marijuana use is losing its grip in the U.S. Since the 1990s, advocates have pushed for a re-evaluation of cannabis (the plant species name often used interchangeably with marijuana) as a viable treatment for a host of ailments. As of 2018, 33 states and the District of Columbia have approved the medical use of cannabis, while 10 states have legalized marijuana for recreational use. Despite this fact, at the federal level, marijuana remains a Schedule 1 drug under the Controlled Substances Act, defined as a drug with no currently accepted medical use and a high potential for abuse.

New research from the University of Michigan, published in the February issue of Health Affairs, takes a deeper dive into state medical marijuana registry data to provide more insight into its use.

“We did this study because we wanted to understand the reasons why people are using cannabis medically, and whether those reasons for use are evidence based,” says lead author Kevin Boehnke, Ph.D., research investigator in the department of anesthesiology and the Chronic Pain and Fatigue Research Center.

He and his U-M colleagues Daniel J. Clauw, M.D., a professor of anesthesiology, medicine, and psychiatry and Rebecca L. Haffajee, Ph.D., assistant professor of health management and policy, as well as U-M alum Saurav Gangopadhyay, M.P.H., a consultant at Deloitte, sought out data from states with legalized medical use of marijuana.

To examine patterns of use, the researchers grouped patient-reported qualifying conditions (i.e. the illnesses/medical conditions that allowed a patient to obtain a license) into evidence categories pulled from a recent National Academies of Sciences, Engineering and Medicine report on cannabis and cannabinoids. The report, published in 2017, is a comprehensive review of 10,000 scientific abstracts on the health effects of medical and recreational cannabis use. According to the report, there was conclusive or substantial evidence that chronic pain, nausea and vomiting due to chemotherapy, and multiple sclerosis (MS) spasticity symptoms were improved as a result of cannabis treatment.

Evidence-based relief

One major finding of the Health Affairs paper was the variability of available data. Less than half of the states had data on patient-reported qualifying conditions and only 20 reported data on the number of registered patients. The authors also noted that the number of licensed medical users, with 641,176 registered medical cannabis patients in 2016 and 813,917 in 2017, was likely far lower than the actual number of users.

However, with the available data, they found that the number of medical cannabis patients rose dramatically over time and that the vast majority — 85.5 percent — of medical cannabis license holders indicated that they were seeking treatment for an evidence-based condition, with chronic pain accounting for 62.2 percent of all patient-reported qualifying conditions.

“This finding is consistent with the prevalence of chronic pain, which affects an estimated 100 million Americans,” the authors state.

This research provides support for legitimate evidence-based use of cannabis that is at direct odds with its current drug schedule status, notes Boehnke. This is especially important as more people look for safer pain management alternatives in light of the current opioid epidemic.

Notes Boehnke, “Since the majority of states in the U.S. have legalized medical cannabis, we should consider how best to adequately regulate cannabis and safely incorporate cannabis into medical practice.”

Story Source: Read this article on Science Daily

Michigan Medicine – University of Michigan. “What drives patients to use medical marijuana: Mostly chronic pain: New study seeks to understand whether people are using cannabis for evidence-based reasons.” ScienceDaily. ScienceDaily, 4 February 2019. www.sciencedaily.com/releases/2019/02/190204172220.htm.

Summit Pain Alliance pain specialists provide individualized pain management 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 looks at long term back pain sufferers

Back pain is among the most frequently reported health problems in the world. New research published in Arthritis Care & Research, an official journal of the American College of Rheumatology and the Association of Rheumatology Health Professionals, examines patterns in back pain over time and identifies the patient characteristics and the extent of healthcare and medication use (including opioids) associated with different patterns.

The study included a representative sample of the Canadian population that was followed from 1994 to 2011. A total of 12,782 participants were interviewed every two years and provided data on factors including comorbidities, pain, disability, opioid and other medication use, and healthcare visits.

During the 16 years of follow-up, almost half (45.6 percent) of participants reported back pain at least once. There were four trajectories of pain among these participants: persistent (18 percent), developing (28.1 percent), recovery (20.5 percent), and occasional (33.4 percent).

The persistent and developing groups tended to have more pain and disability, as well as more healthcare visits and medication use than those in the recovery and occasional trajectory groups. The recovery trajectory group increased the use of opioids and antidepressants over time.

“The good news is that one in five people with back pain recovered; however, they continued to use opioids and antidepressants, suggesting that people recovering from back pain need ongoing monitoring,” said lead author Mayilee Canizares, PhD, of the University Health Network’s Krembil Research Institute in Toronto, Canada. “The bad news was that one in five experienced persistent back pain, with an additional group — almost one in three — who developed back pain over time. These two groups were associated with greater pain limiting activity, disability, and depression, as well as increased healthcare and medication use.”

Dr. Canizares noted that the findings suggest that people with back pain are a heterogeneous group that may benefit from different approaches to management rather than a traditional one size fits all approach. “The distinct groups identified in the study may represent opportunities for more individualized treatment and preventative strategies,” she said.

Story Source: Read this article on ScienceDaily — Wiley. “The course of back pain over time.” ScienceDaily. ScienceDaily, 14 January 2019. www.sciencedaily.com/releases/2019/01/190114082856.htm.


Summit Pain Alliance pain specialists provide individualized pain management (including back 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.

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.

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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.

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