Proving That Chronic Pain Isn’t Just In Your Head

People with chronic pain often have been told it is “all in your head.” Now we can actually image brains with a combination of techniques and see actual differences in structure and chemistry that is being linked to chronic pain. The use of radioactive tracers, with PET, MRI and functional MRI scans are showing changing patterns of activity between normal people’s brains and those with chronic pain. The studies have led to several new key concepts, including glial cells and the role certain proteins play in pain expression.

Traditionally, pain has been related to signals of various nerves cell. Sensory nerve cells in the periphery of the body receive signals, then they are transmitted to the brain via the spine and interpreted by the brain, which transmits signals back to periphery. The electrical sensory and motor neurons are the critical components for understanding pain.

Brain Scan

Now we are learning glial cells, which were thought of as structural components – the scaffolding of the nervous system – may be equally or more important in pain. Glial cells support and protect nerve cells. They also produce compounds that may control or contribute to chronic pain. As we identify the compounds, controlling their levels may be the next big discovery in managing chronic pain. One compound that is increased in chronic pain sufferers is the translocator protein. Studying the protein, one can see where glial cell activation has occurred. Using the special scans, the protein and glial cell activity can be measured, and hopefully in the near future, controlled.

Understanding the connection between pain, translocator proteins and glial cells is important to find effective treatments. Medications that may control chronic pain would decrease both translocator protein levels and glial activation. If a medication is working on these cells effectively, then the brain scans may change. As the science improves, hopefully we can use this knowledge to more fully identify the scope of problems with chronic pain and determine effective management strategies that actually work to reverse the changes and return the brain to healthier function.

Minnesota on the Eve of Medical Marijuana

Medical Marijuana in MinnesotaRecently there have been excellent reviews on the state of the science of medical marijuana. Minnesota is about to start its program, but only a handful of people have been approved for the program and there are not many providers interested in participating. So why is medical marijuana off to such a slow start in Minnesota?

Medical cannabis is a complex subject, after attending many lectures on the subject, and reviewing significant amounts of literature, the one main conclusion is that the science behind cannabinoids is only in its infancy. For the average reader, the Time Magazine May 14, 2015 and the National Geographic July, 2015 issues have good information. At a higher level for medical science, the June 23/30, 2015 issue of the Journal of the American Medical Association has more data.

US Lags Behind

The United States has not been a leader in the study of marijuana. Since marijuana has been labeled a Schedule 1 compound by the DEA, its scientific analysis in the U.S. has been extremely limited. Some of the best research initially has come out of Israel where many of the cannabinoid compounds have been isolated, and in Spain where some of the cancer research and other studies have been done. The most recent issue of JAMA has reviewed a large number of medical studies with regards to a variety of conditions. For the scientist, it is clear there is a significant shortage of information supporting claims of effectiveness of the compounds for most conditions. Most information is based on a very limited numbers of study participants. Comparing the information to almost all other drugs on the market, these studies would barely qualify for drug approval.

The quality of studies for marijuana and chronic pain has been especially limited. The studies researched include neuropathic pain and cancer pain. Most of the studies just looked at a numeric pain scale to measure success and did not quantify any other objective measure like functional ability. The outcome was a modest improvement in reported pain level, but deeper evaluation did not show any changes in quality of life measures when compared to placebo or standard treatments.

After reading multiple articles on cannabinoids and pain, one clear message is present. First, there are a number of different cannabinoid compounds, probably well over a hundred. Second, the chemistry is poorly understood and the effectiveness to treat a variety of medical conditions is limited. Medicine has become a very science driven field. Physicians are constantly under fire to provide care that is safe and effective. The current status for medical marijuana is truly still in the research phase. We won’t be able to fully embrace medical marijuana as a viable option until we know more about all of its compounds.

Vaccines Could Help Prevent Arthritis Symptoms

Traditional methods of treating rheumatoid arthritis involve physical therapy to slow down disease progression and alleviate symptoms, but researchers say they are excited about a new potential treatment option.

According to researchers, they’ve developed a vaccine-like option that might be a gamechanger when it comes to rheumatoid arthritis, because it fights the underlying causes of RA. A clinical trial published in Science Translational Medicine said the vaccine has been proven safe and effective in its treatment of RA.

“Current therapies only treat the symptoms and slow the progression of disease,” said Professor Ranjeny Thomas, head of the autoimmunity division at the University of Queensland Diamantina Institute in Australia. “We have designed a vaccine-style treatment or ‘immunotherapy’ specifically for individuals carrying high-risk rheumatoid arthritis genes and specific rheumatoid arthritis antibodies, called anti-CCP. This treatment teaches the patient’s immune system to ignore a naturally occurring peptide that is incorrectly identified as ‘foreign,’ resulting in the production of CCP antibodies and causing inflammation.”

Rheumatoid Arthritis

How It Works

Interestingly, the vaccine isn’t made of “foreign” components. According to researchers, the serum was developed by taking blood from each patient suffering from RA, treating and retraining the cells, and then re-injecting the blood back into the patient. The injection of the modified cells was proven to be safe, and it actually helped stop RA flares before they began.

Although it looks like a good avenue to continue exploring, researchers said the current methods used to treat a patient through this method is too burdensome.

“At this stage, the technique would not be ideal for widespread treatment or prevention of rheumatoid arthritis because it’s costly and time-consuming,” said Thomas. “However, the promising results of this trial lay the foundations for the development of a more cost-effective, clinically-practical vaccine technology that could deliver similar outcomes for patients,” she added.

Other doctors have faith in the science as well. Natural health practitioner Jenna Stone said using a person’s own treated cells to combat a condition is a great idea to test.

“It makes sense that a vaccine created by a patient’s own modified cells would in essence retrain their immune system, if they have an autoimmune disorder. In autoimmune illnesses like rheumatoid arthritis, we see the immune system attacking healthy cells instead of harmful invaders like it was created to do.”

Hopefully we can conduct more clinical trials on this technique and greatly reduce the cost and time consumption needed to develop this vaccine. I think it could be very beneficial for patients with RA.

Related source: HealthLine

Pain Doctors Looking To The Painless For Possible Solutions

Pierce BrosnanIf you’re a James Bond fan, you may remember the 1999 film, The World is Not Enough. The movie’s villain is a Russian terrorist named Renard who suffers from a rather unique condition. During an encounter with British agent 009, Renard gets shot in the head. However, like most bad guys in the movies, the oft-would-be kill shot doesn’t end up being a fatal blow. Renard’s doctor saves his life, but he is unable to remove the bullet, as doing so would kill the man. Eventually, the bullet will claim Renard’s life, but until that time, its presence in his medala oblong gata renders him almost senseless, dulling his ability to smell, taste and even feel pain.

Although the events leading up to Renard’s condition are unique, the inability to feel pain is not. Many people are unable to sense pain, which may sound appealing, but it can actually be very dangerous. After all, pain is one of the quickest ways our body tells us that something is wrong.

Inability to Feel Pain

The inability to feel pain is known in the medical community as congential insensitivity to pain. It is part of a larger set of disorders known as hereditary sensory and autonomic neuropathy.

As we mentioned above, it may sound cool to feel “invincible,” but it can leave you open to injury. For example, let’s say you have the condition and you set your hand on a hot stove. You’ll still suffer the burns, but you won’t realize you’re being burned. See how this could be an issue?

Interestingly, it’s the pain-free that the pain community are turning to to address the problem of chronic pain. Researchers at Cambridge University have recently pinpointed the exact gene responsible for the pain-free condition, and they’re trying to replicate its expression to help find new pain management avenues.

According to researchers, knowing the underlying mechanisms of pain sensations are critical to controlling and reducing pain, especially because some current methods are ineffective or addictive.

“We are very hopeful that this new gene could be an excellent candidate for drug development, particularly given recent successes with drugs targeting chromatin regulators in human disease,” said Dr. Ya-Chun Chen, the study’s first author.

Obviously the treatment strategy is in the beginning stages, but it’s encouraging for the future of pain management. The key here will be to find a delicate balance between helping people achieve chronic pain relief without dulling the senses so much that the individual is in danger.

Related Source: Medical Daily

Talking Therapy May Help Ease Chronic Pain

Talking therapy, where patients focus on easing psychological stress to make it easier to complete physiological activities, may be another avenue for chronic pain sufferers.

The therapy – also referred to as Contextual Cognitive Behavioral Therapy or CCBT – works by helping people overcome stress that can exacerbate chronic pain symptoms. For example, some people with chronic pain may become stress/fear avoidant, meaning they’ll avoid certain activities simply because they fear the potential outcome. Not only can limited activities make a chronic pain condition worse, but it can also make it harder for the patient to fully overcome the condition.

“We know that for some people with chronic low back pain psychological stress is a major factor, and therefore there is a significant challenge to find effective treatments,” said Dr. Stephen Simpson, director of research and programs at Arthritis Research UK. “This pilot study has shown that combining physical and psychological approaches could be the way forward to treat this common, often disabling condition more effectively.”

Talking Study

For their study, researchers recruited 89 patients with chronic back pain and split them into two groups. The first group received just physiotherapy, while the second group received CCBT and physiotherapy. After completing their assigned therapy, researchers noted that physiotherapy was more successful if patients also received CCBT. Additionally, patients who received both therapies said they believed CCBT helped them be successful in physiotherapy.

“Our study found that CCBT is acceptable to patients,” said Tamar Pincus, a professor at Royal Holloway University of London. “Interestingly many patients who took part, as well as several of the clinicians involved — both psychologists and physiotherapists — thought the best treatment was a combination of both physiotherapy and CCBT.”

Researchers concluded that physiological treatment is just as important as physical treatment when dealing with chronic pain, as mental therapy can improve patient conditions and reduce treatment costs.

Related source: UPI.com