What Virtual Reality Can Teach Us About Chronic Pain

February 23, 2015 / Thomas Cohn, MD

Virtual reality may be the next innovation in the gaming world, but it also may offer real world benefits for chronic pain sufferers.

According to research published in Psychological Science, virtual reality is being used to see how physical and physiological factors impact chronic pain. Researchers say that misrepresenting physical positions through virtual reality can change how someone experiences pain. For example, researchers would outfit patients with a virtual reality device that appeared to show their neck torqued in a position of discomfort to determine how a perceived position impacts brain signals.

“Our findings show that the brain does not need danger messages coming from the tissues of the body in order to generate pain in that body part — sensible and reliable cues that predict impending pain are enough to produce the experience of pain,” said researcher G. Moseley of the University of South Australia. “These results suggest a new approach to developing treatments for pain that are based on separating the non-danger messages from the danger messages associated with a movement.”

The Virtual Study

To see how virtual movements impacted chronic pain perception in your brain, researchers recruited 24 chronic pain sufferers whose pain stemmed from several different conditions, including poor posture, tension, repeated strain, trauma and scoliosis. Participants were equipped with a virtual reality head-mounted display and were positioned to prevent excessive torso movement.

Once the headsets were in place, researchers asked participants to rotate their head until they experienced pain. What the participants didn’t know is that their virtual reality devices either:

Provided an accurate representation of their neck rotation.

Projected an over-rotated representation of the person’s neck.

Projected an under-rotated representation of the person’s neck.

After looking at the data, researchers uncovered that the feedback display had a significant impact on when the participant reported pain. Researchers found:

When head rotation was understated, participants rotated their heads about 6 percent farther than normal before reporting pain.

When head rotation was overstated, pain-free range of motion was reduced by an average of 7 percent.

Intensity of pain did not differ across the various representations.

“We were surprised at how robust and predictable this pattern of results was,” said Moseley. “If cues signaling danger amplify or indeed trigger pain, then these cues present a novel target for therapy.”

How Friends With Pain Affects Your Pain

February 2, 2015 / Thomas Cohn, MD

A recent article in the journal Current Biology found that humans and mice exhibit more pain when with friends with pain than with strangers without pain issues. Those who are with friends with pain will report more severe symptoms than when they are with strangers. Furthermore, people exhibited more pain related behavior in these situations. The researchers hypothesized that when friends had pain, we make a bigger deal about it than when our companions are pain free. As a pain practitioner, it should be a shame on the researchers for jumping to such conclusions.

All pain patients find living with chronic pain is extremely difficult. Pain is mentally fatiguing and depressing. It is a constant battle to control symptoms. Most of the time the battle to control pain is fought alone. People who do not have the problem usually do not want to hear about other people’s medical issues. Others also do not want to be brought down emotionally by the struggles of someone else since they have their own problems.

When one meets another who shares the same problems you have, one may tend to be more honest in the portrayal of your own issues. It is not that you are making your pain sound worse than it is, you just are actually reporting how bad are the symptoms. A person with the same problem is likely to better understand what the other is saying. The communication is more honest and more clear cut. There is also no fear of shame that pain is a significant problem.

Pain Support Groups

The concept of a support group hinges on the fact of a common understanding of a problem. Chronic pain severely affects many people, impacting all aspects of their lives. In normal relationships, one often tries to hide medical problems. We all figure few people understand the problem and we do not need to be shamed by disbelief. Meeting someone who understands the problem of pain and the impact allows the person with pain to be honest about their concerns. To the outsider, this is likely to be seen as embellishment of the pain.

The researchers who wrote this study about pain patients being more open and “feeling worse” when with others who have pain may not be looking at the responses correctly. It is likely that those with pain were just being on honest with how they were feeling when they were with friends who had similar problems. When with strangers, people with pain will often just bite the bullet and act as if everything is okay. No one wants to be known as a complainer. The bottom line in this story is that 40% of the population suffers pain, so maybe we need to show a little more compassion for those with this problem.

Study: Chronic Pain Linked To Activation of Brain’s Glial Cells

January 14, 2015 / Thomas Cohn, MD

A new study published in Reuters Health suggests that doctors may soon have another area to target when it comes to treating chronic pain: your brain’s glial cells.

Researchers said their study indicated that patients with chronic pain often show signs of glial cell activation in areas of the brain that modulate pain.

“Glia appears to be involved in the pathophysiology of chronic pain, and therefore we should consider developing therapeutic approaches targeting glia,” said Dr. Marco L. Loggia, of Massachusetts General Hospital. “Glial activation is accompanied by many cellular responses, which include the production and release of substances (such as so-called ‘pro-inflammatory cytokines’) that can sensitize the pain pathways in the central nervous system. Thus, glial activation is not a mere reaction to a pain state but actively contributes to the establishment and/or maintenance of persistent pain.”

Glial Study

To test the theory that chronic pain sufferers experience activation of brain glia, Dr. Loggia and his team analyzed data from 19 patients with chronic low back pain and 25 non-chronic pain volunteers. After analyzing translocator protein (TPSO) levels associated with the activation of brain glia, researchers found:

Protein increases were significantly higher in patients with chronic low back pain than in the control group.

There were no brain regions in which the control group experienced a higher protein presence than the chronic back pain group.

“It’s important to stress that although TSPO upregulation is a marker of glial activation and therefore of a pro-inflammatory state, animal studies suggest that its role is actually to limit the magnitude of glial responses after their initiation, thereby promoting the return to pre-injury pain-free status and recovery from pain,” said Dr. Loggia. “This means that what we are imaging may be the process of glial cells trying to ‘calm down’ after being activated by the pain. Thus, subjects with low levels of pain-related TSPO upregulation on activated glia may be less able to adequately inhibit neuroinflammatory responses, and have a more exaggerated response that ultimately leads to more inflammation and pain.”

Dr. Loggia continued:

“No objective biomarkers exist to determine if somebody is in pain (i.e. you can’t just hook someone up to a machine to see if they’re experiencing chronic pain). Thus, this study – aside from suggesting glia as a therapeutic target for pain – is important as it may provide an important step toward the identification of objective biomarkers for pain conditions.”

He concluded by saying knowledge of human glial activation had been limited, prior to the study.

“In animal studies we know that glial modulators, which limit glial activation, can potently inhibit or reverse pain,” Dr. Loggia said. “However, evidence of glial involvement in human pain has been very limited until now. Observing glial activation in humans has important potential implications for the development of new therapies based on glial modulation. Seeing that glial activation really happens in patients will provide the rationale to justify a more aggressive exploration of this therapeutic route, and identify which patients are more likely to benefit from these types of therapies.”

Related source: Reuters, Scientific American

Many Nurses Suffer From Lower Back Pain

January 6, 2015 / Thomas Cohn, MD

Researchers in India say nearly 90 percent of nurses across 21 different healthcare facilities in Mumbai and Thane complain of back pain and other muscloskeletal disorders, and nurses in the US may not be much better off.

Researchers at the Nirmala Niketan College of Home Science decided to interview nurses to see how the rigors of keeping others healthy impacts their own health. Nursing isn’t typically considered a physically demanding job, but when you consider how nurses often lift, roll, turn and transfer patients to administer services, you can see how their bodies can wear down.

About 89 percent of nurses surveyed complained of lower back pain or muscloskeletal pain stemming from overuse or misuse of a body part.

“While a majority complained of back pain, others complained of wrist and leg pain. Nurses have a physically demanding job, as they are expected to reposition patients which strain their body also,” said Roopa Rao, an Ergonomics specialist.

As we mentioned above, constant, forceful and repetitive lifting is going to take its toll on body tissues over time. Some hospitals provide nurses with lifting devices to aid in the movement of patients, but not all. The study went on to note that eight out of ten nurses said their pain hindered or interfered with their ability to preform their job duties.

Long Hours

Another issue that may contribute to back problems in nurses is the fact that they often work long hours. Sometimes nurses are called on to work 12-, 14-, 16- and even 18-hour shifts. These long hours take a toll on the body, even if limited lifting is involved. Rao added that the job constraints don’t always allow for regular scheduled breaks. Instead, nurses take their break when there is a lull in the action.

“They are also deprived of a planned break,” said Rao. “Most of their breaks are when there are no duties related to patients to be performed.”

We need to do a better job of taking care of own our. Nurses put so much time and effort into healing others that they may be hurting their own bodies. Nurses and other healthcare workers would benefit from more lifting devices and scheduled breaks, but it’s difficult given budget constraints and patient workload.

Related source: Hindostan Times

The Prevalence of Pediatric Chronic Pain

December 29, 2014January 18, 2016 / Thomas Cohn, MD

Pediatric chronic pain is a growing problem in the United States. According to recent statistics, 1 in 5 children between the ages of 7 and 18 report that they have weekly headaches, and nearly 1 in 10 experience regular abdominal pain. Additionally, 14 percent say they frequently deal with back pain, and four percent are plagued by musculoskeletal pain.

The biggest concern, however, may be that more children are experiencing chronic pain on a regular basis. According to research published in the journal Pediatrics, the number of children admitted to the hospital due to chronic pain rose from 143 in 2004, to 1,188 in 2010 – an increase of 831 percent. With a growing need for pediatric pain treatment, it’s no wonder that more than 30 hospitals nationwide have opened pediatric pain centers of the past few years. These centers provide children with:

Specialized care

Acupuncture sessions

Unique exercise facilities

Sleep specialists

Extensive outpatient therapy treatment

“Kids may be having more pain than in previous generations, but physicians are also more attentive to it and doing more about it,” said Dr. Navil Sethna, clinical director of the rehabilitation center at the Mayo Family Pediatric Pain Rehabilitation Center, one of the top pediatric pain centers in America. Clinics like the Mayo Family Center focus on treating difficult chronic conditions, like fibromyalgia, frequent migraines or ailments resulting from a virus or other injury.

Dr. Lonnie Zektzer, director of the children’s pain and comfort care program at Mattel Children’s Hospital ULCA, said he’s referred children to the Mayo Family Center, and those types of clinics are growing in demand.

“Such programs are becoming more of a trend because they’re so badly needed.”

Pain Management vs. Pain Cure

For many of these facilities, curing the pain is the ultimate goal, but that’s not always possible. Instead, these clinics focus on helping children manage their pain and strengthen their bodies so they experience a gradual reduction in pain over time.

“We teach them how to handle any pain that comes from getting jostled in a hallway or gym class,” said Jenna Duckworth, an occupational therapist who works at the Mayo Family Pediatric Rehabilitation Center.

Judy Gaughan, a nurse and clinical coordinator at the same facility echoed Duckworth’s sentiments, saying, “The treatment goal is to maintain and regain function, not a complete alleviation of pain.”

The center notes that nearly 90 percent of children who finish their program still experience pain symptoms, but the majority report a gradual reduction over several months as they return to normal life.

A 2012 study also shows that the center is improving chronic conditions in children without heavy reliance on painkillers. Nearly all of the 56 children admitted to the program during its first year were taking fewer prescription pain medications 10 months after discharge, the children on meds were usually on a non-addictive preventative drug, and 30 percent weren’t on pain meds at all.

Related source: Boston Globe