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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.

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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.

Study points to physiological pathway responsible for pain perception

A study led by Boston Children’s Hospital and the National Institute of Mental Health (NIMH) may open up new opportunities for treating neuropathic pain, a difficult-to-treat type of chronic pain due to damage to the nervous system that can make the lightest touch intensely painful. In a report today in Nature, scientists led by Zhigang He, PhD, and Clifford Woolf, PhD, of the F.M. Kirby Neurobiology Center at Boston Children’s, demonstrate that neurons that originate in the brain’s cortex influence sensitivity to touch.

The circuit could help explain why mind-body techniques to control pain seem to help many people.

“We know that mental activities of the higher brain — cognition, memory, fear, anxiety — can cause you to feel more or less pain,” says Woolf. “Now we’ve confirmed a physiological pathway that may be responsible for the extent of the pain. We have identified a volume control in the brain for pain — now we need to learn how to switch it off.”

A mind-body pathway

Pain sensation was previously believed to originate with neurons in the spinal cord receiving sensory information from the body and relaying it on to the brain. The new study found that a small group of neurons in the cortex can amplify touch sensation, sending projections to the same parts of the spinal cord that receive tactile sensory information from the body (known as the dorsal horns).

“The anatomy of this circuit has been known for some time, but no one actually looked at its function before,” says He.

“In normal conditions, the touch and pain layers of the spinal cord are strongly separated by inhibitory neurons,” elaborates Alban Latremoliere, PhD, one of four co-first authors on the paper. “After nerve injury, this inhibition is lost, leading to touch information activating pain neurons. When the spinal neurons that are supposed to be pain-only send this information to the brain, we feel pain.”

He, Woolf and colleagues think the cortical neurons they identified could be a potential target for treating the tactile component of neuropathic pain, via drugs or possibly brain electrical stimulation, breaking a feedback loop that introduces and exaggerates the pain response to normally non-painful touch.

When the team severed these neurons or silenced them genetically in a mouse model of neuropathic pain, the mice stopped recoiling from light, innocuous touches, such as stroking with a soft paintbrush or placement of a bit of tape on the bottom of a foot. But the mice retained their sensitivity to truly painful stimuli, reflexively withdrawing their paws when exposed to heat, cold or pinpricks.

Teasing out nerve circuits

The researchers used recently developed technologies to visualize and target specific groups of neurons in the brain and spinal cord. This enabled them to observe the results when different neurons were activated or silenced in a mouse model, and observe which circuits were activated when mice were exposed to noxious or innocuous stimuli.

He notes that some clinicians have tried using brain stimulation as a way of treating neuropathic pain, not always successfully.

“Our findings might help us target the stimulation to particular areas or groups of neurons,” says He. “It might be interesting to look at clinical data and try to replicate the stimulation in animals, and see what kind of stimulation would silence these neurons.”

With functional imaging technologies, investigators could probe what kinds of interventions maximally inhibit this circuit, adds Woolf.

“We now have the ability to silence or activate whole groups of neurons and image their patterns of electrical firing with single-neuron resolution,” he says. “None of this was possible 10 years ago.”

Yuanyuan Liu, Alban Latremoliere and Zicong Zhang (Boston Children’s Hospital) and Xinjian Li (NIMH) were co-first authors on the paper. (Latremoliere is now at Johns Hopkins Medical School.) Kuan Hong Wang (NIMH) was co-senior author together with He and Woolf. The study was supported by the Craig Neilsen Foundation, the Paralyzed Veterans of America Foundation, the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation, the National Institute for Neurological Disorders and Stroke, the NIMH (ZIA MH002897) and the Boston Children’s Hospital IDDRC (NIH P30 HD018655, P30EY012196).


Read this article on ScienceDaily: Boston Children’s Hospital. “Minding the brain to curb pain hypersensitivity: Scientists isolate neurons in the brain that could be targeted to dampen pain from touch.” ScienceDaily. ScienceDaily, 12 September 2018. www.sciencedaily.com/releases/2018/09/180912133437.htm.

Study of phantom limb pain leads to more effective treatment

The patient, missing his right arm, can see himself on screen in augmented reality, with a virtual limb. He can control it through the electrodes attached to his skin, which allows the patient to stimulate and reactivate those dormant areas of the brain. Credit: Max Ortiz Catalan - Science Daily

Dr Max Ortiz Catalan of Chalmers University of Technology, Sweden, has developed a new theory for the origin of the mysterious condition, ‘phantom limb pain’. Published in the journal Frontiers in Neurology, his hypothesis builds upon his previous work on a revolutionary treatment for the condition, that uses machine learning and augmented reality.

Phantom limb pain is a poorly understood phenomenon, in which people who have lost a limb can experience severe pain, seemingly located in that missing part of the body. The condition can be seriously debilitating and can drastically reduce the sufferer’s quality of life. But current ideas on its origins cannot explain clinical findings, nor provide a comprehensive theoretical framework for its study and treatment.

Now, Max Ortiz Catalan, Associate Professor at Chalmers University of Technology, has published a paper that offers up a promising new theory — one that he terms ‘stochastic entanglement’.

He proposes that after an amputation, neural circuitry related to the missing limb loses its role and becomes susceptible to entanglement with other neural networks — in this case, the network responsible for pain perception.

“Imagine you lose your hand. That leaves a big chunk of ‘real estate’ in your brain, and in your nervous system as a whole, without a job. It stops processing any sensory input, it stops producing any motor output to move the hand. It goes idle — but not silent,” explains Max Ortiz Catalan.

Neurons are never completely silent. When not processing a particular job, they might fire at random. This may result in coincidental firing of neurons in that part of the sensorimotor network, at the same time as from the network of pain perception. When they fire together, that will create the experience of pain in that part of the body.

“Normally, sporadic synchronised firing wouldn’t be a big deal, because it’s just part of the background noise, and it won’t stand out,” continues Max Ortiz Catalan. “But in patients with a missing limb, such event could stand out when little else is going on at the same time. This can result in a surprising, emotionally charged experience — to feel pain in a part of the body you don’t have. Such a remarkable sensation could reinforce a neural connection, make it stick out, and help establish an undesirable link.”

Through a principle known as ‘Hebb’s Law’ — ‘neurons that fire together, wire together’ — neurons in the sensorimotor and pain perception networks become entangled, resulting in phantom limb pain. The new theory also explains why not all amputees suffer from the condition- the randomness, or stochasticity, means that simultaneous firing may not occur, and become linked, in all patients.

In the new paper, Max Ortiz Catalan goes on to examine how this theory can explain the effectiveness of Phantom Motor Execution (PME), the novel treatment method he previously developed. During PME treatment, electrodes attached to the patient’s residual limb pick up electrical signals intended for the missing limb, which are then translated through AI algorithms, into movements of a virtual limb in real time. The patients see themselves on a screen, with a digitally rendered limb in place of their missing one, and can then control it just as if it were their own biological limb . This allows the patient to stimulate and reactivate those dormant areas of the brain.

“The patients can start reusing those areas of brain that had gone idle. Making use of that circuitry helps to weaken and disconnect the entanglement to the pain network. It’s a kind of ‘inverse Hebb’s law’ — the more those neurons fire apart, the weaker their connection. Or, it can be used preventatively, to protect against the formation of those links in the first place,” he says.

The PME treatment method has been previously shown to help patients for whom other therapies have failed. Understanding exactly how and why it can help is crucial to ensuring it is administered correctly and in the most effective manner. Max Ortiz Catalan’s new theory could help unravel some of the mysteries surrounding phantom limb pain, and offer relief for some of the most affected sufferers.

Read this article on Science Daily: Chalmers University of Technology. “A new theory for phantom limb pain points the way to more effective treatment.” ScienceDaily. ScienceDaily, 6 September 2018. www.sciencedaily.com/releases/2018/09/180906082022.htm.

Dr. Michael Yang On Understanding Pain as We Age – Free Event

Dr. Michael Yang MD will be speaking for a FREE event – Live Your Best Life Now open to the community on Friday October 12th. “Understanding Pain As We Age.” Pain management specialist Michael Yang, MD, will discuss the common misconceptions and myths about pain and aging, and discuss ways to make yourself more comfortable when managing a painful condition. Registration is here: https://vintagehouse.org/events/?eid=4665 Full flyer info below along with registration info.

This is a FREE event - open to the community. “Understanding Pain As We Age.” Pain management specialist Michael Yang, MD, will discuss the common misconceptions and myths about pain and aging, and discuss ways to make yourself more comfortable when managing a painful condition. Dr. Yang utilizes a multidisciplinary approach to pain management in his private practice in Sonoma and Santa Rosa, using a sophisticated combination of medications, new and minimally invasive interventional procedures, and regenerative treatments. He is a graduate of UCSF School of Medicine and completed his residency in anesthesiology at Cornell University.

CLICK TO DOWNLOAD your personal copy of this flyer.

Dr. Hau and Dr. Yang Selected as among ‘Top Doctors’ for 2018

Summit Pain Alliance’s Dr. John Y. Hau and Michael Yang M.D. Selected as ‘Top Doctors’ of 2017 by Sonoma Magazine.

Sonoma Magazine’s Top Doctor survey is submitted every year to Sonoma County doctors who are asked which medical specialist they would most often recommend to a loved one. More than 300 professionals emerged as top docs in 50 categories of medicine. The research organization tasked with this survey deems that medical professionals are the best judges of other medical professional’s clinical excellence, so the survey was sent to all licensed doctors in Sonoma (including Napa and Marin, as well), asking doctors to nominate three physicians in each category. They were instructed to take into account such factors as education, hospital appointment, board certifications and bedside manner and they could not nominate themselves. Dr. Hau and Dr. Yang rose to the top of the survey and were highlighted for their work in Pain Medicine.

About Dr. John Hau, M.D.

Dr. John Y. Hau Top Doctor 2017Dr. John Hau is a Board Certified Anesthesiologist and Board Certified Pain Management Physician. Dr. John Hau completed his undergraduate studies in Molecular and Cell Biology at the University of California, Berkeley, after which he went on to complete his medical school training at Temple University School of Medicine in Philadelphia.

Following medical school, Pain Doctor John Hau completed residency training in anesthesiology at Rush University Medical Center in Chicago, where he was elected chief resident by his peers and faculty during his final year of residency. Dr. John Hau then went on to complete fellowship training in interventional pain management at the University of California, Los Angeles, which is ranked as one of the best hospitals in California and the nation. During his training at UCLA, he learned advanced and cutting edge interventional pain management techniques used in the treatment of many painful conditions. Dr. Hau is proud to join the Petaluma and Santa Rosa community. He currently serves as the Medical Director of Summit Pain Alliance, Petaluma.

About Dr. Michael Yang, M.D.

Dr. Michael Yang M.D. Top Doctor 2017Dr. Michael Yang grew up in Southern California and completed his undergraduate degree with Phi Beta Kappa and Psy Chi honors from Johns Hopkins University with dual majors in Biology and Psychology. He then returned to the west coast where he conducted neurosurgery research at UCLA. Pain Doctor Yang attended UCSF, one of the top five medical schools in the nation, to complete his medical degree. Throughout his medical education, he continued to be interested in the connection between the physical body and the mind. This led him to graduate with honors in psychology and anesthesiology rotations.

After medical school, Dr. Yang moved to New York City where he completed his residency in anesthesiology at Cornell University. After residency, Dr. Yang completed ACGME-accredited fellowship training in the field of pain management from a multidisciplinary approach, working in three of the top hospitals in the nation: Memorial Sloan-Kettering Cancer Center, Hospital for Special Surgery and New York Presbyterian Hospital. From his fellowship and his experience in private practice in Santa Rosa, Dr. Yang treats patients with cancer pain, acute and chronic orthopedic injuries, and various chronic back and nerve pains.

In his free time, Dr. Yang enjoys fishing, tennis, hiking, travel and snowboarding. He looks forward to becoming an integral part of the medical community in Santa Rosa, providing the latest of techniques and innovations to treating his patients.

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. To schedule an appointment call (707) 623-9803.

Brain region associated with mindfulness also linked with lower pain experience

Ever wonder why some people seem to feel less pain than others? A study conducted at Wake Forest School of Medicine may have found one of the answers — mindfulness. “Mindfulness is related to being aware of the present moment without too much emotional reaction or judgment,” said the study’s lead author, Fadel Zeidan, Ph.D., assistant professor of neurobiology and anatomy at the medical school, part of Wake Forest Baptist Medical Center. “We now know that some people are more mindful than others, and those people seemingly feel less pain.”

The study is an article in press, published ahead-of-print in the journal PAIN.

The researchers analyzed data obtained from a study published in 2015 that compared mindfulness meditation to placebo analgesia. In this follow-up study, Zeidan sought to determine if dispositional mindfulness, an individual’s innate or natural level of mindfulness, was associated with lower pain sensitivity, and to identify what brain mechanisms were involved.

In the study, 76 healthy volunteers who had never meditated first completed the Freiburg Mindfulness Inventory, a reliable clinical measurement of mindfulness, to determine their baseline levels. Then, while undergoing functional magnetic resonance imaging, they were administered painful heat stimulation (120°F).

Whole brain analyses revealed that higher dispositional mindfulness during painful heat was associated with greater deactivation of a brain region called the posterior cingulate cortex, a central neural node of the default mode network. Further, in those that reported higher pain, there was greater activation of this critically important brain region.

The default mode network extends from the posterior cingulate cortex to the medial prefrontal cortex of the brain. These two brain regions continuously feed information back and forth. This network is associated with processing feelings of self and mind wandering, Zeidan said.

“As soon as you start performing a task, the connection between these two brain regions in the default mode network disengages and the brain allocates information and processes to other neural areas,” he said.

“Default mode deactivates whenever you are performing any kind of task, such as reading or writing. Default mode network is reactivated whenever the individual stops performing a task and reverts to self-related thoughts, feelings and emotions. The results from our study showed that mindful individuals are seemingly less caught up in the experience of pain, which was associated with lower pain reports.”

The study provided novel neurobiological information that showed people with higher mindfulness ratings had less activation in the central nodes (posterior cingulate cortex) of the default network and experienced less pain. Those with lower mindfulness ratings had greater activation of this part of the brain and also felt more pain, Zeidan said.

“Now we have some new ammunition to target this brain region in the development of effective pain therapies. Importantly this work shows that we should consider one’s level of mindfulness when calculating why and how one feels less or more pain,” Zeidan said. “Based on our earlier research, we know we can increase mindfulness through relatively short periods of mindfulness meditation training, so this may prove to be an effective way to provide pain relief for the millions of people suffering from chronic pain.”


Read this article on Science Daily: Wake Forest Baptist Medical Center. “‘Mindful people’ feel less pain; MRI imaging pinpoints supporting brain activity.” ScienceDaily. ScienceDaily, 7 September 2018. www.sciencedaily.com/releases/2018/09/180907110425.htm.


At Summit Pain Alliance we provide individualized pain management for a pain-free life. For more information and to schedule an appointment call (707) 623-9803.

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