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Vaccines Could Help Prevent Arthritis Symptoms

/ Thomas Cohn, MD

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

The First Phase of Legal Marijuana

/ Thomas Cohn, MD

Medical MarijuanaThe start of legalizing medical marijuana in Minnesota began last Monday. The initial step for patients is to be certified that one has a condition approved for treatment by this medication. Pain is not a condition approved for marijuana in Minnesota. Once certified as having an appropriate condition, the process in Minnesota applying for the medication can begin, and then obtaining the approved medication can occur. One can assume, the medical marijuana oils obtained in Minnesota, will be far different from recreational use marijuana.

In June, 2015, the lead National Geographic article is titled “Weed, The New Science of Marijuana”. It is an excellent review of the knowledge and science of cannabis. The use of marijuana dates back to at least to 3000 B.C.E., but did not become demonized until 1970 when it became a Schedule 1 drug, meaning it had no valid medical purpose. The truth about marijuana is much more complex. The study of marijuana really began only in the early 1960’s compared to the early 1800’s when opium and cocaine became known. Those drugs, which were once taboo, led us to the discovery of morphine and coco leaves. Will marijuana follow a similar path?

The Science Behind Marijuana

In 1963, a young organic chemist by the name of Raphael Mechoulam began experimenting with the compounds in marijuana. After isolating a number of compounds, Mechoulam tested the compounds on monkeys. Only one compound produced a significant effect. As Mechoulam wrote, “normally the rhesus monkey is quite an aggressive individual,” but when injected with this compound, the monkeys became quite calm.

Flash forward a few years, and Mechoulam’s research is helping 20,000 patients get treatment in his home country of Israel for a variety of conditions, including Crohn’s Disease, glaucoma, Tourette’s Syndrome and asthma. Mechoulman says he doesn’t believe the substance should be legalized for recreational use, but he hopes the stigma of studying the compounds for medical research fades now that more people seeing the medical benefits it possesses.

“We have just scratched the surface,” he says, “and I greatly regret that I don’t have another lifetime to devote to this field, for we may well discover that cannabinoids are involved in some way in all human diseases.”

In fact, researchers are using marijuana to combat cancers as we speak. Research in Spain found that some rats with brain tumors were cured of their condition after being injected with THC. The results are quite encouraging, but as biochemist Manuel Guzmán noted, “the problem is, mice are not humans. We do not know if this can be extrapolated to humans at all.”

Think about that for a second. We may have found another potential ally in the war on cancer, but there’s still so much hate for the drug that it’s impeding medical progress. We need to study these compounds in order to provide the best care possible for our patients.

Related source: National Geographic

Addressing The Problem Of Physician Burnout

/ Thomas Cohn, MD

One of the front page articles this week in the StarTribune explored the subject of doctor burnout. Every job comes with stress; Medicine is not immune to stress and burnout is becoming a more recognized phenomenon. Many jobs have the pressure to perform, but many doctors try harder to push through the stress and daily duties. Recently, we began to realize we are no different than everyone else.

Medicine has for a long time been a very strenuous career. The academic requirements and training are very difficult. Most of us started our careers with residency training involving workweeks that exceeded 80 hours, and we continued working 50-60 hours each week after residency was complete. The time spent seeing patients is only a fraction of the time spent – many more hours involve paperwork, patient preparation, administrative tasks, and continuing education. Family and fun time become eclipsed by work requirements, and sleep is an afterthought.

Tired Doctor

Daily Doctor Stresses

Stress becomes a lifestyle. Seeing patients and being able to identify the correct diagnosis and treatment is always a challenge. Many physicians also perform complex procedures that could easily cause significant damage if something goes wrong, adding to the stress. Then, if patient is at all unhappy, we may have to deal with administrators questioning the encounter or the possibility of being sued.

Preventing stress and burnout in any profession is necessary. One may be busy, but to prevent burnout, one needs to take time out from work. Physicians need to do this just like everyone else. Some physicians take extended breaks from practice, taking months off at a time. They do charity work and get away from their normal practice. Others limit their work hours. Many try to find outside interests to focus on to reduce stress. No one goes to their graves saying that they wished they spent more time at work.

Work is only a small part of life. Maintaining outside interests is essential. Stress comes as part of the profession. Ways to handle the stress include maintaining good fitness and having outside interests that you enjoy. Often, the outside interests of a physician can be seen readily at their offices. A physician with no outside life besides medicine may be more likely to become burned out. Stress reduction for everyone is necessary. It is summer time and now is a time to be outside and enjoy the world.

 

Insomniacs More Prone to Chronic Pain

/ Thomas Cohn, MD

Findings out of the Norwegian Institute of Public Health suggest that people who have trouble sleeping are more likely to have an increased sensitivity to pain.

Although the study didn’t show a cause-and-effect relationship, researchers said insomniacs were more likely to be sensitive to pain. For the study, researchers asked more than 10,000 adults to dip their hands in cold water for 1 minute and 46 seconds. If they felt the cold water was causing too much pain, participants could remove their hands from the water prior to the completion of the timer.

Insomnia

After their reading was recorded, researchers asked participants a bunch of questions about their sleeping habits, including how long they typically sleep, how long it takes them to fall asleep, and if they suffer from insomnia. Researchers also asked questions about related issues that can make it hard to fall asleep, like anxiety, stress and depression.

Study Results

After looking at the findings, researchers uncovered:

  • Nearly 1/3 of participants were able to keep their hands in the water for the entire test.
  • 42 percent of people with insomnia pulled their hands out of the water early.
  • 31 percent of people without the sleep disorder pulled their hands out of the water early.
  • Participants with frequent insomnia were more likely to remove their hands from the water than people who have insomnia once a month.
  • People with insomnia and chronic pain were twice as likely to have a reduced pain tolerance than participants without those conditions.

“While there is clearly a strong relationship between pain and sleep, such that insomnia increases both the likelihood and severity of clinical pain,” researchers wrote, “it is not clear exactly why this is the case.”

Dr. Cohn Comments

Although the findings are interesting, they are hardly revolutionary. In fact, it’s more of a chicken-and-the-egg type argument. People who have chronic pain are more likely to be plagued by nagging pain, which can make it difficult to fall asleep and stay asleep, and if you don’t get a full night’s sleep, your body can fully recover from the activities of the day, contributing to more pain. So what came first, the chronic pain or the insomnia?

Related source: Health.com

Dopamine May Be Key To Unlocking Chronic Pain

/ Thomas Cohn, MD

DopamineMedical researchers at the University of Texas say dopamine – the mechanism in your brain responsible for movement, memory and reward – could provide the key to unlocking the problem of chronic pain.

Dopamine is vital for several different brain functions, but its contributions to the problem of chronic pain are not well known. To better understand dopamine’s role in chronic pain transmission, researchers began studying its effect in mice. Researchers noted that removing a specific collection of neurons -known as A11 – helped diminish the perception of chronic pain. The cluster of A11 neurons contained high levels of dopamine.

“These findings demonstrate a novel role for how dopamine contributes to maintaining chronic pain states,” said associate professor Dr. Ted Price.

How it Works

When a person gets injured, neurons inside the body send pain signals to the brain. In someone with chronic pain, these neurons send pain signals to the brain even when an injury isn’t present. A physical medicine pain specialist’s job is to determine what is causing these neurons to fire, and how to stop them from incorrectly firing.

The A11 cluster might be causing some of these neurons to fire. In fact, when removed, mice were still able to feel acute pain (an actual physical injury), but they exhibited a lesser response to chronic pain.

“We used a toxin that affected A11 neurons, and that’s when we found that acute pain signals were still normal, but chronic pain was absent,” said Dr. Price. “This may open up new opportunities to target medicines that could reverse chronic pain,” said Dr. Price.

Dr. Price and colleagues want to continue studying dopamine receptors in relation to chronic pain perception.

“In future studies, we would like to gain a better understanding of how stress interacts with A11. And we’d like to know more about the interaction between molecular mechanisms that promote chronic pain and dopamine.”