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Dr. Yang Interview Excerpt – Focus on Inflammation

The word inflammation comes from the Latin word inflammationem, which means “a setting on fire.” Certainly anyone who has experienced the feelings of heat, redness, swelling, pain and burning that makes the origin of this word an accurate description. But what exactly is inflammation and how can it hurt—as well as help—your body?

At its most basic definition, inflammation is the body’s natural reaction to an injury or infection—its attempt to heal itself. So, while we generally have negative connotations to the word, we are nevertheless fortunate that the body has this built-in immune system in place to recognize damaged cells, irritants and pathogens to heal an injury or fight an infection. Though inflammation may be uncomfortable, it is the body’s biological response to remove a harmful affect on the body. Without it, infections, wounds, and other damage to tissue couldn’t heal.

“Inflammation overall is an immune response,” says Kim Kulp, registered dietician at Santa Rosa Memorial Hospital. “It’s your body’s way of trying to fix any foreign invader, or some damage to the body,” adds Kulp, who is also the owner of her own private practice, Health Tastes Great, seeing patients in both Novato and Mill Valley.

Generally, once the injury or infection is healed, the inflammation should stop. This normal process is usually identified as acute inflammation. However, when inflammation does not dissipate, but lingers in the body long term it becomes chronic inflammation and can lead to a variety of other diseases.

“Acute and chronic [inflammation] is just a descriptor of the chronicity, or the time, that the inflammation has taken place in your body,” says Michael Yang, M.D., Santa Rosa-based Summit Pain Alliance, a leader in pain management in Northern California, which provides cutting edge technologies, pain management therapies, and advancements in pain relief, both acute and chronic. “Generally, in the field of pain management, we demarcate that at about six months. It’s not an exact science, but we have to draw the line somewhere, so it’s generally accepted that anything beyond six months is considered chronic pain. Inflammation is exactly that. So, if you’ve had an inflammatory response in a certain body part and if it’s been there longer than six months, it’s considered chronic.”

A silent precursor to disease

Unfortunately, chronic inflammation is not only uncomfortable or painful, but more and more research shows a link to a variety of diseases. According to Harvard Medical School, “…research on inflammation has created a shift in medical thinking. For two millennia, it has been viewed mainly as a necessary, even beneficial, response to illness or injury. But now both observational studies and laboratory research are indicating that inflammation can be more of a bane than boon, the common, causative factor in many diseases.” Research now shows inflammation may be a common underlying cause of many major degenerative diseases, including coronary artery disease, diabetes, cancer and Alzheimer’s.

“Inflammation itself can be harmful to the body, even though it’s the body’s way of bringing in the healing factors,” says Yang. “If it’s chronic and it’s constantly bringing in these inflammatory cytokines that cause swelling and redness and pain, all of that is just the body trying to heal itself. But if it’s there on a chronic basis, that in itself can also cause deterioration. In medical terms, anything with –itis at the end of it means inflammation of whatever is in that base word. So, arthritis is inflammation of the joints, appendicitis is inflammation of the appendix, and bronchitis is inflammation of the bronchials. But of course, chronic bronchitis is terrible for you and arthritis—as it gets worse—causes giant swollen joints, which can cause terrible deformities. Chronic inflammation can cause a lot of damage to your body.”

Alarmingly, some inflammation that occurs deep inside the body, such as in an internal organ where there may not be any sensory nerve endings, may not have any visible or noticeable signs that make it immediately obvious what is happening in the body.

“Eventually something will go wrong,” warns Kulp. “You’re not going to be feeling well, or there will be more fatigue, or you might have some symptoms of these diseases. There isn’t just one sign of inflammation.”

Other symptoms that may eventually become present include abdominal or chest pain, fever, joint pain, or a rash, but some of these indicators can seem mild enough to not necessarily seek medical attention. However, today there are certain blood tests that show if an inflammatory process is going on.

“There are parts of the body that have little sensation,” says Yang. “You can have inflammation that is just circulating in the blood stream. You can have inflammation of your bowels, like irritable bowel syndrome and chronic ulcerative colitis—those are bowel inflammations that can wreak havoc on the body, but you don’t feel it until you have a stomach cramp. But the inflammation is there all the time.”

Read entire article on Northbay Biz

Study examines knee pain and impaired knee function relate to depression

In the U.S., about 13 percent of women and 10 percent of men aged 60 or older have knee pain due to osteoarthritis (OA). Osteoarthritis occurs when a joint becomes inflamed, usually because the protective cartilage and other tissues that cushion joints like the knee become damaged and worn over time. Knee pain from OA can make it harder to take care of yourself, which can damage your quality of life. In turn, that can lead to depression.

According to researchers, knee OA affects some 55 percent of people over age 40 in Japan. A research team from the country recently published a study in the Journal of the American Geriatrics Society examining the effects of knee pain on depression since, until now, few studies have focused on how knee pain and impaired knee function relate to depression.


To learn more, the researchers examined information from 573 people aged 65 or older who participated in the Kurabuchi Study, an ongoing look at the health of older adults living in central Japan.

When the study began (between 2005 and 2006) none of the participants had symptoms of depression. Two years later, nearly all of them completed follow-up interviews. The participants answered questions about their knee pain and were evaluated for symptoms of depression.

Nearly 12 percent of the participants had developed symptoms of depression. People who experienced knee pain at night while in bed, while putting on socks, or while getting in or out of a car were more likely to report having symptoms of depression, noted the researchers.

The researchers concluded that asking older adults with knee pain whether they have pain at night in bed, when putting on socks, or while getting in or out of a car could be useful for helping to screen people at risk for developing depression.

Read this article on Science Daily: American Geriatrics Society. “Is knee pain linked to depression?.” ScienceDaily. ScienceDaily, 23 March 2018. www.sciencedaily.com/releases/2018/03/180323121750.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.


Researchers discover a novel use of illusion to alter knee pain

In a new study published in the journal Peer J this week, researchers at UniSA’s Body in Mind Research Group have found people suffering osteoarthritis in the knees reported reduced pain when exposed to visual illusions that altered the size of their knees.

UniSA researcher and NHMRC Career Development Fellow, Dr Tasha Stanton says the research combined visual illusions and touch, with participants reporting up to a 40 per cent decrease in pain when presented with an illusion of the knee and lower leg elongated.

“We also found that the pain reduction was optimal when the illusion was repeated numerous times — that is, its analgesic effect was cumulative,” Dr Stanton says.

The small study — 12 participants — focused on people over 50 years with knee pain, and a clinical diagnosis of osteoarthritis.

Dr Stanton says the research provides “proof of concept” support that visual illusions can play a powerful role in reducing pain.

“We have shown that pain is reduced significantly when a visual stimulus, in this case a smaller or an elongated joint, is provided, but not only that, when exposed to that illusion repeatedly, pain decreases even further,” she says.

“It seems that seeing is believing, and by understanding the neurological processes at work we may be able to ease pain more effectively for people with chronic conditions, reduce their reliance on medications and find alternative physical therapies to help manage conditions like osteoarthritis.

“This research adds to a growing body of evidence that the pain experienced in osteoarthritis is not just about damage to the joint.

“There are other factors at play and the more we understand about these natural mechanisms for reducing pain and how they are triggered, the more opportunity we have to develop a range of treatments to manage chronic conditions.”


Read this article on ScienceDaily: University of South Australia. “Visual illusion proves effective in relieving knee pain for people with osteoarthritis.” ScienceDaily. ScienceDaily, 18 July 2018. www.sciencedaily.com/releases/2018/07/180718092451.htm.

Injured athletes improve pain tolerance and awareness with meditation

A new study of injured athletes carried out by the University of Kent found they can benefit from using mindfulness as part of the sport rehabilitation process to improve their pain tolerance and awareness. The research, carried out by Dr Warhel Asim Mohammed and Dr Athanasios Pappous (School of Sport and Exercise Sciences) and Dr Dinkar Sharma (School of Psychology) could have major implications in the treatment of sporting injuries at all levels.

Every year there are 29.7 million injuries among athletes in the UK. These have both psychological and physiological effects on athletes and for some it may mean the end of a career in sport.

To understand if mindfulness could play a part in the rehabilitation process of injuries, the researchers conducted tests on 20 athletes (14 male, six female), aged from 21-36 years who had severe injuries, preventing their participation in sport for more than three months.

Both groups followed their normal physiotherapy treatment but, in addition, the intervention group practised mindfulness meditation in one 90-min session per week for eight weeks.

A Cold Pressor Test (CPT) was used to assess pain tolerance. In contrast, the perception of pain was measured using a Visual Analogue Scale. Other measurements used were the Mindful Attention Awareness Scale (MAAS), Depression Anxiety and Stress Scale (DASS), and Profile of Mood States (POMS).

Results demonstrated an increase in pain tolerance for the intervention group and an increase in mindful awareness for injured athletes. Moreover, there was a promising change in positive mood for both groups. Regarding the Stress/Anxiety scores, findings showed a notable decrease across sessions.

The study used a common meditation technique, based on Mindfulness-Based Stress Reduction (MBSR), as an intervention for utilisation during the recovery period of injured athletes — this is the first study using MBSR as an intervention for this purpose.

The aim of this research was to investigate the role of MBSR practise in reducing the perception of pain and anxiety/stress and increasing pain tolerance and mindfulness. Additionally, the aim was to increase positive mood and decrease negative mood in injured athletes.

Sport injuries are a considerable public health concern. The impact of the injured athlete extends beyond the individual. Although it may impact on their seasonal and potential career performance, it additionally impacts upon the clubs and organisations for whom they perform. Furthermore, it leads to a greater general burden on the health service.

Further research is required to assess whether increasing pain tolerance could help in the therapeutic process.


 

Read this article on Science Daily: University of Kent. “Mindfulness helps injured athletes improve pain tolerance and awareness.” ScienceDaily. ScienceDaily, 26 June 2018. www.sciencedaily.com/releases/2018/06/180626113350.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.

How ending opioid treatment for chronic pain is helping patients

Stopping long-term opioid treatment does not make chronic, non-cancer-related pain worse and, in some cases, makes it better, Washington State University researchers have found.

The research marks a crucial first step towards understanding how ending long-term opioid therapy affects patients with different types of chronic pain and could help medical practitioners identify effective, alternative treatments to opioids.

“On average, pain did not become worse among patients in our study a year after discontinuing long-term opioid therapy,” said Sterling McPherson, associate professor and director for biostatistics and clinical trial design at the WSU Elson F. Floyd College of Medicine. “If anything, their pain improved slightly, particularly among patients with mild to moderate pain just after discontinuation. Clinicians might consider these findings when discussing the risks and benefits of long-term opioid therapy as compared to other, non-opioid treatments for chronic pain.”

In the study

McPherson and colleagues at the Veteran Affairs Portland Health Care System and the Oregon Health & Science University used survey responses from 551 VA patients who had been on long-term opioid therapy for chronic, non-cancer-related pain for at least a year before discontinuing the medication.

Eighty-seven percent of the patients were diagnosed with chronic musculoskeletal pain, 6 percent with neuropathic pain, and 11 percent with headache pain, including migraines.

Survey subjects rated their pain over two years, scoring it on a scale of 0-10 where 0 equals no pain and 10 equals the worst possible pain. The researchers used biostatistical analysis and computer modeling to characterize changes in pain intensity 12 months before the patients ended opioid therapy and the 12 months after.

While patients differed widely in the intensity of pain they experienced before and after stopping opioids, as a whole, their pain did not get worse and remained similar or slightly improved.

“Our results indicate that long term opioid therapy does not effectively manage patient pain intensity any more effectively than not receiving long-term opioid therapy,” McPherson said. “There are a variety of treatments available for the management of chronic pain other than opioids and our hope is that this research will help promote conversations about these alternatives between doctors and their patients.”

Next steps

McPherson plans to collect additional data and conduct qualitative interviews with patients over the next year to try and determine why some patients experience greater reductions in pain than others after discontinuing long-term opioid therapy

“As part of our study, we grouped our patients into one of four categories based on the amount of pain they reported before and after discontinuing long-term opioid therapy,” McPherson said. “We are now going to try and understand what different mechanisms may be at work for reducing or increasing chronic pain for each of these sub-groups. Our hope is this will lead to being able to target specific sub-populations with different types of treatment for their chronic pain. In addition, we hope to continue to characterize potential adverse effects from being discontinued from long-term opioid therapy.”

A national problem

Backaches, headaches and other chronic, non-cancer-related pains affect one-third of Americans and will afflict even more as the prevalence of diabetes, obesity, arthritis and other diseases grows in the United States’ aging population.

From the early 1990s through 2012, powerful opioid painkillers were increasingly used to treat these maladies in the United States. But a growing number of opioid-related overdose deaths has caused U.S. doctors and policymakers to reexamine this approach. According to the Centers for Disease Control and Prevention, more than 63,600 Americans died from drug overdose deaths in 2016, a toll five times higher than in 1999. Two thirds of these deaths, 42,249, involved opioids.

McPherson’s study, which appears in the June edition of the journal Pain, is one of the first to investigate what, if any, are the potential adverse effects of discontinuing long term opioid therapy for chronic, non-cancer-related pain.

Read more

New Study Explores Genetic Connection of Migraines

The nauseating, often debilitating, headaches affect 15-20 percent of adults in developed countries, yet they remain stubbornly hard to explain. Scientists know that migraines tend to run in families but aren’t sure exactly how. A new study published in the journal Neuron shows why some families are susceptible to migraines and how genetics may influence the type of migraine they get.

“For a long time, we have been wondering why common disease (like migraines) aggregates in families,” said Aarno Palotie of the Institute for Molecular Medicine in Finland and the Broad Institute of MIT and Harvard in Cambridge, Mass.

Previous migraine research identified two ways migraines might run in families. Linkage studies, which track sections of chromosomes passed down from parent to child, identified three genes (CACNA1A, ATP1A2 and SCN1A) associated to hemiplegic migraine, a severe form of migraine that induces stroke-like symptoms. These genes fall under a Mendelian inheritance model, meaning the two copies of a gene a child inherits from his or her parents determine a trait or disease. Sickle cell anemia could be thought of as Mendelian.

Another way migraines could run in families involves polygenic inheritance. If a trait is polygenic, that means that a group of genes collectively influence that characteristic. Like being dealt a bad hand in a card game, each common genetic variant may have only a small individual effect, but the collection of common variants builds up to influence the trait — or disease risk — a person inherits. Height is an example of a polygenic trait.

Palotie and his colleagues set out to find out whether a few, powerful Mendelian genes or a polygenic accumulation of common variants — or a combination of both — influenced how migraines are inherited in families.

First, the researchers developed a polygenic risk score to estimate the genetic burden of common variants. To do this, they gathered data from a previous genome-wide association study, which is a type of study that compares genomes of individuals and flags loci (locations on chromosomes) that differ in people with a disease. In all, hundreds (possibly even thousands) of loci linked to migraines were incorporated into the polygenic risk score.

Next, the researchers tested the influence of the polygenic risk score and the three known Mendelian migraine-linked genes within a large family study of migraine sufferers in Finland. The study included medical history and genetic data of 1,589 families (made up of 8,319 individuals) of known migraine sufferers. The family migraine cohort was compared against other large cohorts as a control, such as the FINRISK study that had 14,470 people total, including 1,101 people with migraine.

Result after result showed that the polygenic common variants were driving migraine risk more than the three Mendelian genes. If a person’s migraines started at an earlier age, if a person experienced more severe migraines, or if migraines ran in a person’s family, the data showed that it’s more likely that person had a greater genetic burden of common polygenic variants to blame.

“The strength of the common variants in these families surprised us,” said Palotie.

On the other hand, the three rare but powerful Mendelian genes linked to migraine didn’t seem to influence migraine risk as much as the researchers expected. Out of the large family study, researchers identified 45 families with hemiplegic migraine and sequenced their genes. Migraines in only four out of 45 families were driven by the rare Mendelian genes — more cases were driven by common variants.

“This really shows, in a very big sample set, that common variants are very important factors in aggregation of migraines in the family,” said Palotie.

Palotie believes more genome sequencing and larger studies will help researchers find both more common variants linked to migraines and more Mendelian variants.

“This is of special interest for drug development,” said Palotie. Even if Mendelian variants don’t drive the majority of migraine cases, scientists can research how these genes impact biological pathways responsible for migraine symptoms and potentially develop drugs to target those pathways.


Read this on Science Daily:  “New light on genetic foundation of migraines.” ScienceDaily. ScienceDaily, 3 May 2018. www.sciencedaily.com/releases/2018/05/180503142926.htm.

Customized resistance exercise may benefit women with Fibromyalgia

with proper support and individually adjusted exercises, female patients achieved considerable health improvements, according to research

Fibromyalgia and resistance exercise have often been considered an impossible combination. But with proper support and individually adjusted exercises, female patients achieved considerable health improvements, according to research carried out at Sahlgrenska Academy, Sweden.

“If the goal for these women is to improve their strength, then they shouldn’t be afraid to exercise, but they need to exercise the right way. It has long been said that they will only experience more pain as a result of resistance exercise, that it doesn’t work. But in fact, it does,” says Anette Larsson, whose dissertation was in physical therapy and who is an active physical therapist.

As part of her dissertation, she studied 130 women aged between 20-65 years with fibromyalgia, a disease in which nine of ten cases are women. It is characterized by widespread muscle pain and increased pain sensitivity, often combined with fatigue, reduced physical capacity and limitation of activities in daily life.

About half of the women in the study (67) were selected at random to undergo a program of person-centered, progressive resistance exercise led by a physical therapist. The other 63 women comprised the control group and underwent a more traditional therapy program with relaxation exercises. The training and exercises lasted for fifteen weeks and were held twice a week.

“The women who did resistance exercise began at very light weights, which were determined individually for each participant because they have highly varying levels of strength. We began at 40 percent of the max and then remained that level for three to four weeks before increasing to 60 percent,” explains Anette Larsson.

More than six of ten women were able to reach a level of exercise at 80 percent of their maximum strength. One of the ten was at 60 percent; the others were below that figure. Five individuals chose to stop the training due to increased pain. The group as a whole had 71 percent attendance at the exercise sessions.

“On a group level, the improvements were significant for essentially everything we measured. The women felt better, gained muscle strength, had less pain, better pain tolerance, better health-related quality of life and less limitation of activities. Some of the women did not manage the exercise and became worse, which is also an important part of the findings,” says Anette Larsson.

In the control group, the improvements were not as significant, but even there, hand and arm strength improved. The relaxation exercises probably led to reduced muscle tension in the arms and shoulders, which in turn allowed the participants to develop more strength.

The findings for the women in the resistance exercise group are affected by several factors, including the degree of pain and fear of movement before and during the exercise period. Progress for the group as a whole can largely be attributed to the person-centered approach, with individually adjusted exercises and loads and support of a physical therapist, according to Anette Larsson.

“An interview study we conducted shows clearly that the women need support to be able to choose the right exercises and the right loads; they also need help when pain increases. This requires, quite simply, support from someone who knows their disease, preferably a physical therapist.”

Title: Muscle strength and resistance exercise in women with fibromyalgia — a person-centered approach; http://hdl.handle.net/2077/55397

Read this article on Science Daily:

University of Gothenburg. “Customized resistance exercise a factor for success with fibromyalgia.” ScienceDaily. ScienceDaily, 7 June 2018. www.sciencedaily.com/releases/2018/06/180607120709.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.

Physical therapy benefits low-back pain patients

Patients with low-back pain are better off seeing a physical therapist first, according to a study of 150,000 insurance claims.

The study, published in Health Services Research, found that those who saw a physical therapist at the first point of care had an 89 percent lower probability of receiving an opioid prescription, a 28 percent lower probability of having advanced imaging services, and a 15 percent lower probability of an emergency department visit — but a 19 percent higher probability of hospitalization.

The authors noted that a higher probability of hospitalization is not necessarily a bad outcome if physical therapists are appropriately referring patients to specialized care when low back pain does not resolve by addressing potential musculoskeletal causes first.

These patients also had significantly lower out-of-pocket costs.

“Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physical therapists as well as to educate patients about the potential benefits of seeing a physical therapist first,” said lead author Dr. Bianca Frogner, associate professor of family medicine and director of the University of Washington Center for Health Workforce Studies.

Frogner said individuals in all 50 states have the right to seek some level of care from a physical therapist without seeking a physician referral, however, many do not take advantage of this option. She said this may be because some insurance companies have further requirements for payment.

About 80 percent of adults experience back pain at some point during their lifetime, according to the National Institutes of Health.

Currently, patients with low-back pain are given painkillers, x rays and, in some cases, told to rest, said Frogner. She said said seeing a physical therapist first and given exercise is a more evidence-based approach.

Using an insurance claims dataset provided by the Health Care Cost Institute, the researchers reviewed five years of data of patients newly diagnosed with low back pain who had received no treatment in the past six months. The claims were based in six states: Washington, Wyoming, Alaska, Montana, Idaho and Oregon.

The research involved the UW School of Medicine in Seattle and The George Washington University in Washington, D.C.

“This study shows the importance of interprofessional collaboration when studying complex problems such as low-back pain. We found important relationships among physical therapy intervention, utilization, and cost of services and the effect on opioid prescriptions,” said Dr. Ken Harwood, lead investigator for The George Washington University.

Story Source: Read this article on Science Daily: University of Washington Health Sciences/UW Medicine. “Early physical therapy benefits low-back pain patients: Analysis of 150k claims shows health, cost upsides.” ScienceDaily. ScienceDaily, 22 May 2018. www.sciencedaily.com/releases/2018/05/180522225553.htm.

Happy Clinical Trials Day

At Summit Pain Alliance we are proud to take part in the evolution of medical technology. We are constantly working to make our solutions more effective for our patients, with several ongoing clinical trials and many more to come we can do just that. Our highly trained Clinical Research Team will make sure every trial is conducted with the highest level of quality. Visit our Clinical Trials section to learn more, and contact us for information to discover how to become a participant.

The Clinical Trials Back Story

James Lind’s experiment with citrus fruit was one of the first reported clinical trials in medicine

May 1747. The HMS Salisbury of Britain’s Royal Navy fleet patrols the English Channel at a time when scurvy is thought to have killed more British seamen than French and Spanish arms. Aboard this ship, surgeon mate James Lind, a pioneer of naval hygiene, conducts what many refer to as the first clinical trial.

Acting on a hunch that scurvy was caused by putrefaction of the body that could be cured through the introduction of acids, Lind recruited 12 men for his “fair test.” (Ed: Historians are at odds regarding whether Lind secured Institutional Review Board approval before proceeding with subject recruitment, but largely agree his Informed Consent process did not measure up to modern standards.)

From The James Lind Library: Without stating what method of allocation he used, Lind allocated two men to each of six James Lind's experiment with citrus fruit was one of the first reported clinical trials in medicinedifferent daily treatments for a period of fourteen days. The six treatments were: 1.1 litres of cider; twenty-five millilitres of elixir vitriol (dilute sulphuric acid); 18 millilitres of vinegar three times throughout the day before meals; half a pint of sea water; two oranges and one lemon continued for six days only (when the supply was exhausted); and a medicinal paste made up of garlic, mustard seed, dried radish root and gum myrrh. (Ed: The existence accountability logs is yet another area of disagreement among historians, but many agree that Lind’s Essential Documents binder might have settled at the bottom of the English Channel.)

Those allocated citrus fruits experienced “the most sudden and good visible effects,” according to Lind’s report on the trial.

Though Lind, according to The James Lind Library, might have left his readers “confused about his recommendations” regarding the use of citrus in curing scurvy, he is “rightly recognized for having taken care to ‘compare like with like’, and the design of his trial may have inspired” and informed future clinical trial design.

*Additional information provided here: James Lind: The man who helped to cure scurvy with lemons 

Experiencing trauma as a child may contribute to a lifetime of pain

Experiencing trauma as a child may influence how much pain an individual feels in adulthood. Gaining insight about who feels more pain and why is important as issues like the opioid crisis continue to escalate.

Experiencing trauma as a child may influence how much pain an individual feels in adulthood, according to Penn State researchers. Gaining insight about who feels more pain and why is important as issues like the opioid crisis continue to escalate.

The researchers found that experiencing trauma or adversity in childhood or adolescence — such as abuse or loss of a parent — was linked with mood or sleep problems in adulthood, which in turn led to experiencing greater physical pain. But, the connection was weaker in those who felt more optimistic and in control of their lives.

“The participants who felt more optimistic or in control of their lives may have been better at waking up with pain but somehow managing not to let it ruin their day,” said Ambika Mathur, graduate student in biobehavioral health. “They may be feeling the same amount or intensity of pain, but they’ve taken control of and are optimistic about not letting the pain interfere with their day. They’re still performing their work or daily activities while doing their best to ignore the pain.”

The findings — recently published in the Journal of Behavioral Medicine — build on previous research that suggests a link between adult physical pain and early-in-life trauma or adversity, which can include abuse or neglect, major illness, financial issues, or loss of a parent, among others.

Jennifer Graham-Engeland, associate professor of biobehavioral health, said it’s important to learn more about the factors that influence pain, because while pain medications help a lot of people, they can also cause problems.

“Pain is the number one reason people seek health care in the United States,” Graham-Engeland said. “We know that a lot of people are seeking pain relief, and yet there are a lot of problems with some pain treatments, like the crisis surrounding opioids right now. We need more insight into pain and the phenomenon that can make pain both better or worse.”

For the current study, a diverse group of 265 participants who had all reported some form of adversity early in their lives answered questions about their early childhood or adolescent adversity, current mood, sleep disturbances, optimism, how in control of their lives they feel, and if they recently felt pain.

The researchers found that early childhood or adolescent adversity was strongly associated with more physical pain in adulthood, which could be explained by troubles with mood — which could include anger, depression or anxiety — or sleep.

“Basically what’s happening is mood and sleep disturbances are explaining the link between early life adversity and pain in adulthood,” Mathur said. “The findings suggest that early life trauma is leading to adults having more problems with mood and sleep, which in turn lead to them feeling more pain and feeling like pain is interfering with their day.”

The researchers also looked at how optimism or feeling in control could affect how much pain a person experiences. They found that while participants who showed these forms of resilience didn’t have as strong of a connection between trouble sleeping and pain interfering with their day, resilience didn’t affect the intensity of pain.

Jennifer Graham-Engeland said that while it’s too early to use the results in targeted interventions, the findings suggest important next steps.

“This study does build on a body of research showing a connection between early life adversity and pain, but also that some people can achieve resilience,” Jennifer Graham-Engeland said. “Some people can be relatively resilient to adverse effects in the longer term, while others have a harder time. So better understanding those resources that people are able to draw on was a reason for this work and I think needs to be further investigated.”

This work was supported by the National Institutes of Health’s National Institute of Aging.

Martin J. Sliwinski, Penn State; Joshua M. Smyth, Penn State; Danica C. Slavish, Penn State (now at University of North Texas); Richard B. Lipton, Albert Einstein College of Medicine; and Mindy J. Katz, Albert Einstein College of Medicine, also participated in this research.

Journal Reference:

  1. Ambika Mathur, Jennifer E. Graham-Engeland, Danica C. Slavish, Joshua M. Smyth, Richard B. Lipton, Mindy J. Katz, Martin J. Sliwinski. Recalled early life adversity and pain: the role of mood, sleep, optimism, and controlJournal of Behavioral Medicine, 2018; DOI: 10.1007/s10865-018-9917-8

Read this article on Science Daily: Penn State. “Adversity early in life linked with more physical pain in adulthood.” ScienceDaily. ScienceDaily, 9 May 2018. www.sciencedaily.com/releases/2018/05/180509104928.htm.