Monday, May 30, 2011
Thursday, May 19, 2011
Researchers studying the link between pain and such thinning had hoped that successfully treating back pain would halt that process. Instead, it reversed it. Six months after surgery or spinal injections, a brain region associated with pain -- the dorsolateral prefrontal cortex -- had thickened.
"We thought it would be able to slow down the thinning, but to actually recover was pretty amazing," says study researcher Laura S. Stone, PhD, a neuroscientist at McGill University in Montreal.
The study is published in The Journal of Neuroscience.
Stone and colleagues recruited 18 patients who were seeking treatment for chronic lower back pain, which they had had for at least a year. Prior to treatment, each patient had an MRI to measure cortical brain thickness and to assess brain activity during a simple cognitive test. Fourteen of those patients underwent similar testing half a year later. Their tests were compared to scans of 16 people without back pain.
"The extent of the thickening was surprising to us," says study co-researcher David A. Seminowicz, PhD, of the University of Maryland School of Dentistry. "Every patient who had less pain or decreased disability after treatment showed a thickening in that area."
That area is the dorsolateral prefrontal cortex, which plays an important role in how we perceive pain. While it was the only brain region that showed significant thickening after treatment, several other regions appeared to improve as well.
"There was a trend in a lot of different areas to get thicker," says Seminowicz, who is now planning studies to look at the long-term impact that treating back pain may have on the brain.
Link Between Pain and Brain Function
Pain also puts increased demands on the brain. Patients with lower back pain show an abnormal amount of brain activity when performing the same tasks as those who do not suffer from such discomfort. They often report difficulty concentrating, says Stone. In testing, they show impaired abilities in cognitive tasks and decision making, which may be related to the distracting influence of pain and the demands it puts on the brain.
Stone did not measure how well patients perform on such cognitive tests. But her study does show that patients who had undergone successful treatment for back pain had brain activation levels approaching those of healthy people.
While pain appears to be the cause of the thinning, it's not understood exactly how it happens, says Stone.
"Is it cells dying? Or do other things happen? Do the cells shrink? We don't know," she says. "But if we can figure out what causes the thinning and the thickening, we may be able to develop therapies that target that mechanism."
Wednesday, May 18, 2011
Thursday, May 12, 2011
Wednesday, May 11, 2011
A movement in recent decades to treat pain more aggressively has brought relief to many patients, allowing them to work and live better-quality lives.
But it has exacted a steep price -- an epidemic of drug overdoses, deaths and narcotic drugs diverted to illegal street sales.
"We've got two big public health problems -- millions of people in pain who can benefit from opioids and the exponential rise in prescription drug abuse. The drugs aren't dangerous. But they have to be used thoughtfully," said Steven Passik, a clinical psychologist at Memorial Sloan-Kettering Cancer Center in Manhattan.
Passik and other pain care experts recall that it wasn't so long ago when doctors were reluctant to treat pain with prescription narcotics. No more.
Physicians prescribed 257 million opioids in 2009, an amount that translates into billions of doses. Opioid sales in the United States increased 627 percent from 1997 to 2007, according to data presented recently by the Centers for Disease Control and Prevention.
What happened illustrates how something created to do good can also have unintended bad consequences.
The spread of hospice in the 1970s brought attention to the undertreatment of pain in cancer patients. In response, the prescribing of opioids to cancer patients and those near death became accepted practice.
Physicians and advocacy groups then pushed for greater use of narcotics to treat longer-term pain in patients with noncancer ailments as well. They were aided by the conventional wisdom at the time, based on what little research was available, that said opioids rarely caused addiction or other problems.
Attitudes about pain and its treatment began to change.
In the 1990s, health care organizations issued broad principles for the management of chronic pain. Others promoted pain relief as a patient right.
States passed laws and rules to lessen fear among doctors of criminal charges or professional sanctions.
By 2001, the Department of Veterans Affairs adopted the American Pain Society's concept of pain as the "fifth vital sign," encouraging physicians to assess for pain just as they would check a pulse. The Joint Commission, which accredits hospitals and nursing homes, also started using guidelines requiring the measurement of pain.
Meanwhile, pharmaceutical companies aggressively promoted painkillers to doctors, many of whom receive little or no training in pain management or drug addiction.
Critics cite Purdue Frederick, parent company of Purdue Pharma, to show how marketing amplified the availability of prescription narcotics. In 2001 alone, the company spent $200 million to promote OxyContin, a drug that abusers crushed to defeat its extended-release action.
Purdue denied such a connection in 2007 when three executives pleaded guilty to a misdemeanor charge that the company misled doctors by claiming OxyContin was less addictive than other painkillers because it was long-acting.
"It's hard to overstate the devastation OxyContin brought to the coal states. There was a tsunami of addiction," said Dr. Art Van Zee, a Virginia physician who has written about Purdue.
But perspectives vary on the issue, and doctors bear the ultimate responsibility for making medical decisions.
Ellen Battista, a Buffalo pain specialist, cautioned against overemphasizing the role of drug companies.
"The pharmaceutical industry doesn't take our pens and write prescriptions," she said.
All the influences led more doctors, often encouraged by patients, to prescribe opioids more often and in larger doses to more people in pursuit of an elusive goal -- the end of pain.
Unfortunately, it turned out that treating cancer patients with prescription painkillers was not the same as treating pain in the general population. The risks and benefits of long-term narcotic use for chronic pain proved to be much trickier than originally thought, requiring a cautious approach and closer supervision of patients.
"The medical community underestimated its power to make things worse. We created a culture that says existential suffering can be treated by a pill, procedure or device," said Dr. Alex Cahana, a pain specialist involved in developing new regulations in Washington State.
Increasingly, physicians were being duped by patients, while others were either out of date with appropriate opioid prescribing, dishonest or disabled by the drugs themselves.
"When you look back, there was a rallying cry to treat chronic pain more effectively," said Aaron M. Gilson, senior researcher at the University of Wisconsin's Pain & Policy Studies Group. "But there wasn't a firm foundation of education, skills or research to do it."
Monday, May 09, 2011
The actor reprises his role as Captain Jack Sparrow in the latest instalment of the hit franchise, but admits he spent three weeks of the shoot in agony as he struggled to hide his pain.
He tells the Hollywood Reporter, "I must have done something to my back during a stunt and ended up with this bad sciatic situation. It was this horrible, grinding electricity going through me.
"I kept shooting; there was no choice. I'd just limp on set. It was monstrous, man - so horrible that I actually started to like it! It was bad, and I had it a good three weeks to a month. But I got used to it and kind of missed it when it was gone."
Sunday, May 08, 2011
Wednesday, May 04, 2011
A few years ago a security expert visited Eli Lilly's vast warehouse in Enfield, Conn., one of the pharmaceutical giant's three U.S. distribution sites, where hundreds of millions of dollars' worth of prescription drugs are stored. The expert was surprised to see the facility lacked a perimeter fence. There wasn't even a $10-an-hour guard stationed outside. But Lilly officials assured the consultant there was nothing to be concerned about. Recalls the expert: "They were very proud to show me. 'We have four-foot-thick walls.'"
He then looked up at the ceiling. "I was like, 'What's up there?'" he says. "There" turned out to be a standard tar roof with no extra reinforcement or fortification. Sometime later, Lilly's security team suggested changes to protect the Enfield warehouse, including installing a fence. But those proposals went unheeded, according to two security experts in a position to know. Bob Reilley, Lilly's chief security officer, says the company had a response in the works. But to listen to him today, it didn't seem that urgent. "That warehouse had been there about 20 years in a nice industrial area," Reilley says, "and was part of the community as well."
Sure enough, Lilly's (LLY) Enfield warehouse became the site of a headline-making heist -- the largest pharmaceuticals theft in history. The burglars struck in the early-morning hours of Easter Sunday last year, as a heavy rain and windstorm knocked down trees and power lines, occupying local police.
Security was so lax that they pulled their tractor-trailer directly up to the loading dock and parked there for hours. Security cameras recorded the image of the truck, but no one was monitoring the cameras. The burglars drilled a hole in the tar roof and slid down ropes into the warehouse. Once inside, they disabled an alarm panel with a sledgehammer.
Another alarm went off at some point during the burglary, say those familiar with the break-in. Staff at ADT, which monitored the system, called the first name listed on Lilly's contact sheet and left a message. By the time a Lilly employee responded, the burglars were gone, along with $75 million worth of cancer, psychiatric, and blood-thinning drugs.