Sciatica Patients Still Do Better With Steroids Than With Etanercept, Study Shows

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Article Date: 17 Apr 2012 - 2:00 PDT Current ratings for:
Sciatica Patients Still Do Better With Steroids Than With Etanercept, Study Shows

Despite the great promise that injecting a new type of anti-inflammatory pain medicine into the spine could relieve the severe leg and lower back pain of sciatica, a Johns Hopkins-led study has found that the current standard of care with steroid injections still does better.

Etanercept, sold by the brand-name Enbrel, is a genetically engineered small-protein drug known as a tumor necrosis factor inhibitor (TNF). Currently, it is used to treat rheumatoid arthritis and other autoimmune disorders in which the immune system attacks healthy tissue causing pain, swelling and damage. The drug blocks TNF, a naturally produced substance that causes inflammation.

Although steroids combat inflammation generally, TNF inhibitors specifically target the inflammatory molecules causing sciatica and other pain conditions, and keep them from binding to receptors in the central nervous system, potentially preventing the pain altogether.

A team led by Steven P. Cohen, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, conducted a blinded, placebo-controlled study, providing epidural injections of either 60 milligrams of a steroid, 4 milligrams of etanercept, or 2 milliliters of saline to 84 adult patients with sciatica. One month after the second of two injections, the patients on steroids reported less pain and less disability than those in the other two groups. The study is published in the April 17 issue of the Annals of Internal Medicine.

Cohen said studies with etanercept grew out of efforts to prevent or limit the pain that commonly comes from a herniated disc pressing on a nerve root in the lower back or neck. Steroids work, he said, but they are not without drawbacks, including mixed and only temporary results in relieving pain, and the potential for catastrophic complications. Pain experts have long been working to try to find an alternative treatment that is safe and reliable, he notes.

"People are desperate for a safer, more effective drug," Cohen says. "This new treatment shows a lot of promise, but at least in the doses we gave it - the dose known to be safe - steroids still work better. And in those lower doses, etanercept may not be the drug everyone's hoping it is. There's still a lot more work to be done."

Cohen says a study published last month found that patients who received more than twice as much etanercept as was used in his study felt better than those who got steroids one and two weeks after their injections, but not four weeks out. The dose of etanercept administered by Cohen's team - 4 milligrams - was deemed to be the optimum dose found to be both safe and effective in a pilot study done by Cohen and colleagues in patients and animals.

The idea behind administering an epidural injection for sciatica is to bathe the spinal nerve roots directly in a medication designed to reduce inflammation - and pain - in order to give the body time to heal itself, Cohen says. This allows for better relief at lower doses and, in turn, fewer side effects than when the medications are given by mouth or intravenously.

The new study found that more patients treated with epidural steroids (75 percent) reported 50 percent or greater leg pain relief and felt better overall after one month compared to those who received saline (50 percent) or etanercept (42 percent). On a pain scale of 0 to 10, with 10 denoting the worst pain, those who received steroids reported, at one month, an average pain score of 2.1 compared with 3.6 in the etanercept group and 3.8 in the group injected with saline. Those in the steroid group also reported lower levels of disability (21 percent) than those in the saline group (29 percent) or etanercept group (38 percent).

After six months, however, slightly more patients in the saline (40 percent) and etanercept (38 percent) groups had a positive outcome than those in the steroid group (29 percent).

"The effect of the steroids didn't last," Cohen says, "affirming the fact that steroids work, but not for very long."

Cohen says research now needs to be done to test the safety and effectiveness of higher doses of etanercept and other drugs that block the inflammatory molecules responsible for pain.

View drug information on Enbrel.Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our back pain section for the latest news on this subject. Funding for the study was provided by the John P. Murtha Neuroscience and Pain Institute, the International Spinal Intervention Society and the Center for Rehabilitation Sciences Research.
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'Sciatica Patients Still Do Better With Steroids Than With Etanercept, Study Shows'

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Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss

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Article Date: 04 Dec 2012 - 1:00 PST Current ratings for:
Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss

Postmenopausal women suffered significant bone density loss in their hip after they were treated with an epidural steroid injection for back pain relief, according to a Henry Ford Hospital study

Bone density loss after six months was six times greater when compared to the typical bone density loss seen in a year in a postmenopausal woman who doesn't receive steroid injection, researchers say.

Shlomo Mandel, M.D., a Henry Ford orthopedic physician and the study's lead author, says physicians should exercise caution prescribing an epidural steroid for select patients, suggesting that multiple injections may compromise bone strength.

"The findings of our study suggest that epidural steroid injections for back pain relief should be approached cautiously in patients at risk for bone fragility," Dr. Mandel says. "Physicians who do prescribe them should consider measures that optimize bone health such as calcium and vitamin D supplements and exercise as part of their patient's treatment plan.

The study was published in Spine.

Back pain is one of the most common medical conditions in the United States, affecting 8 out of 10 people at some point during their lives. As people age, their spine ages with them, causing degenerative changes in the spine.

Patients are typically treated with anti-inflammatory drugs and physical therapy. If symptoms persist, an epidural steroid is often prescribed to alleviate pain and improve function. However, steroid use has been linked to diminished bone quality.

In the observational study, Henry Ford sought to evaluate whether steroid injections used for treating lumbar stenosis, increased the risk of bone loss in postmenopausal women. Lumbar stenosis is an abnormal narrowing of the spine canal. Twenty-eight patients, aged 65 and older and treated between 2007-2010, were evaluated for bone loss using bone density testing and serum biochemical markers prior to receiving an injection, then at three- and six-month intervals.

The bone loss data was compared to bone loss data for postmenopausal women who hadn't been treated with an epidural injection.

"Patients receiving multiple steroid injections with a history of steroid exposure may be especially susceptible to compromised bone strength," Dr. Mandel says.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our bones / orthopedics section for the latest news on this subject. The study was funded by Henry Ford Hospital.
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'Postmenopausal Women Treated With Steroid Injection For Back Pain At Significant Risk For Bone Loss'

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The Molecular Mechanism Responsible For Vertebral Column Degeneration Discovered

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Article Date: 15 Mar 2012 - 1:00 PDT Current ratings for:
The Molecular Mechanism Responsible For Vertebral Column Degeneration Discovered

Italian researchers at the Catholic University of Sacred Heart in Rome found an important molecular mechanism responsible for low back pain and other acute vertebral problems like cervical axial pain, all due to aging and degeneration of the vertebral column.

The team led by Dr. Luigi Aurelio Nasto and Enrico Pola also developed an experimental drug to inhibit this degenerative mechanism, by blocking its principal culprit, the molecule, "NF-kB" and tested it successfully in mice. The study was carried out in collaboration with the University of Pittsburgh research team led by Paul Robbins, James Kang and Nam Vo.

Researchers reported their findings in the journal Spine.

Nasto and Pola found that high concentration of NF-kB causes the degeneration of intervertebral discs (the structures that separate and damp the vertebrae), a degenerative process that could affect also young adults (30 year old), especially if they adopt a sedentary lifestyle. In other words when NF-kB becomes overactive, it triggers a series of deleterious reactions that ultimately affect the physiological structure of the vertebral column.

Due to aging, obesity and sedentary lifestyle, intervertebral discs degenerate, leading to the progressive stiffening of the column. The intervertebral disc degeneration is responsible for syndromes such as chronic low back pain or neck pain that affects a large proportion of the adult population.

Back pain and neck pain are ranked among the leading causes of lost working hours and disability in adults Italian scientists found the mechanism behind the degenerative processes of the column. They studied mice that are genetically programmed to age rapidly (progeroid mice). The average lifespan of normal mice is 2 years. The progeroid mice age more quickly and have a lifespan of 8 months. The progeroid mice perfectly mimic the process of spine degeneration that occur in old people and young adults who suffer from low back pain.

The researchers found that NF-kB plays a role in the degeneration of the spine. NF-kB is a transcription factor, it modulates the activation of specific target genes. Researchers found that NF-kB activates many genes related to inflammation and turn off anti-inflammatory protective genes. Moreover in many studies NF-kB was found hyperactive in both the spines of old mice and old people.

The results of the Italian research suggest that NF-kB induces the onset of deleterious inflammatory processes and inhibit anti-inflammatory mechanisms. Moreover "our study shows that by inhibiting NF-kB, we can stop spine degeneration", Dr. Nasto says. "Drugs that turn off or even only partially inactivate NF-kB could be used to prevent the degeneration of intervertebral discs in patients."

"In our study, we developed a specific drug, called NBD peptide, able to specifically inhibit the deleterious action of NF-kB - dr Pola explains. NBD has been already successfully tested by a US team in Pittsburgh to slow the course of muscular dystrophy in an animal model (NF-kB is also involved in this disease). This peptide will be soon tested in a clinical trial (phase I) to study its therapeutic effects on Duchenne muscular dystrophy".

According to Nasto and Pola, NBD may also be used to counteract the aging of the vertebral column. "We hope to develop other selective inhibitors of NF-kB to slow the degeneration of intervertebral discs" and cure low back pain, Pola concludes.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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posted by Mary Treacy on 20 Mar 2012 at 9:35 am

This research sounds very promising and will hopefully lead to a cure for Vertebral Column Degeneration and relief for millions of sufferers. We have a whole section written by one such patient on our site dedicated to the spinal column and back problems and what can be done to prevent them and hopefully we will be able to use this information to update the site and offer extra hope to our readers at a later date.

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'The Molecular Mechanism Responsible For Vertebral Column Degeneration Discovered'

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2-Level Axial Lumbar Interbody Fusion May Lead To Complications

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Article Date: 23 Jul 2012 - 1:00 PDT Current ratings for:
2-Level Axial Lumbar Interbody Fusion May Lead To Complications

Surgeons from the Instituto de Patologia da Coluna in Sao Paulo, Brazil have found that an innovative minimally invasive surgical procedure performed to achieve two-level axial lumbar interbody fusion produced immediate successful results, but within 2 years complications set in, making the procedure far less desirable. Findings of this study are reported in the article "Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up. Clinical article," by Luis Marchi, Leonardo Oliveira, Etevaldo Coutinho, M.D., and Luiz Pimenta, M.D., Ph.D., published online in the Journal of Neurosurgery: Spine.

The report stems from a prospective, nonrandomized single-center study of 27 patients who underwent presacral axial lumbar interbody fusion (AxiaLIF [TranS1, Inc.]) surgery at two levels: L4-5 and L5-S1. Surgery was performed to correct symptomatic lumbosacral degenerative disc disease, degenerative low-grade spondylolisthesis, or failed-back surgery syndrome. The patients suffered from low-back pain, radicular leg pain, or both. Outcomes of the procedures were assessed on the basis of imaging studies (radiographs and CT scans) and patient-reported questionnaires (assessments based on applying a visual analog pain scale and the Oswestry Disability Index).

No intraoperative complications were related to the surgical approach. Significant clinical improvement was apparent following surgery. By the 2-year follow-up, patients reported a 50% reduction in back pain and a 40% reduction in disability.

Outcomes of the procedure documented by imaging studies, however, were not as promising. The surgical goals of disc height/foramen space distraction, lordosis gain/maintenance, and spine stabilization appeared to be achieved shortly after surgery; however, as time progressed these achievements were lost and in some cases outcomes were worse than before surgery. In addition, complications abounded: screw breakage (14.8% of patients), rod detachment (11.1%), cephalic rod migration (24%), and radiolucency around the transsacral rod (52%). At 24 months postoperatively, solid spinal fusion had been obtained at both L4-5 and L5-S1 in only 2 patients (8%); fusion had been obtained at L4-5 in 20% of patients and at L5-S1 in 24% of patients.

The authors point out that the AxiaLIF approach has already proved to be effective for creating fusion at one level: L5-S1. In doing this it offers advantages over other techniques because it does not damage the annulus fibrosus or the anterior or posterior longitudinal ligaments. The application of the AxiaLIF technique to two spinal levels is relatively new. In this small study, application of the technique for this purpose was not effective and was accompanied by many complications. The authors suggest that additional studies should be performed to assess the anatomical and application limitations of the technique.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our back pain section for the latest news on this subject. Marchi L, Oliveira L, Coutinho E, Pimenta L. Results and complications after 2-level axial lumbar interbody fusion with a minimum 2-year follow-up. Clinical article, Journal of Neurosurgery: Spine, published online July 17, 2012, ahead of print; DOI: 10.3171/2012.6.SPINE11915.
Disclosure: Clinical and research support for the study (including equipment and material) was provided by TranS1, which markets the AxiaLIF family of products.
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Cancer de la colonne vertébrale : Lignes directrices pour le diagnostic non pris en charge chez les Patients atteints de douleurs lombaires

Catégorie principale : Maux de dos
Également inclus dans : Cancer / oncologie
L'article Date: 28 février 2013 - 0:00 PST courants nominaux pour :
Cancer de la colonne vertébrale : Lignes directrices pour le diagnostic non pris en charge chez les Patients atteints de douleurs lombaires

Une nouvelle revue systématique publiée dans The Cochrane Library a suscité des doutes quant à l'efficacité des indicateurs "drapeau rouge" à identifier et à l'exclusion du cancer chez les patients atteints de douleurs lombaires. Les auteurs de l'étude a conclu que la plupart des drapeaux rouges étaient pauvres à diagnostiquer malignes de la colonne vertébrale et call pour poursuivre ses études axées sur les combinaisons de drapeaux rouges.

Douleurs lombaires sont une plainte fréquente, souvent avec aucune cause évidente. Dans environ 1 à 5 % des personnes souffrant de douleurs lombaires, la condition provient d'un problème sous-jacent plus grave, comme une tumeur. Lignes directrices pour l'évaluation des patients atteints de douleurs lombaires recommandent que les médecins ne commencent immédiatement avec imaging techniques telles que la radiographie et l'IRM.

Au lieu de cela, il leur est recommandé d'effectuer un examen physique et de se pencher sur leurs antécédents médicaux à la recherche de caractéristiques soi-disant drapeau rouge qui peuvent pointer vers une cause plus sérieuse de la racine. Identifier un ou plusieurs de ces caractéristiques indiquerait un besoin pour davantage de tests diagnostiques. Dans une situation idéale, sujets à un risque élevé de malignité spinale seraient identifiés en tenant compte des facteurs comme l'âge et les antécédents de cancer, sans procéder à des essais inutiles dans un grand nombre de patients. Dans la pratique, cependant, il y a peu de preuves qu'à l'aide de ces drapeaux rouges avec précision des diagnostics malignes de la colonne vertébrale.

Les chercheurs ont analysé les données de huit études portant sur un total de 6 622 patients atteints de douleurs lombaires. Ces études utilisé 20 différents drapeaux rouges dont les antécédents de cancer, être plus de 50, aucun soulagement avec repos au lit, inexpliquée perte de poids et aucune amélioration des symptômes après un mois. Bien que dans certaines études, ayant des antécédents de cancer a augmenté la probabilité de détection de la malignité spinale, autres caractéristiques ont été de peu d'utilité pour le diagnostic de malignité spinale. En outre, les drapeaux rouges ont été appliqués dans un grand nombre de patients qui ne présentaient aucun signe de malignité spinale lorsqu'on ont utilisé les techniques d'imagerie.

« À l'exception d'avoir des antécédents de cancer, caractéristiques plus de drapeau rouge sur leurs propres étaient pauvres à prédire la colonne vertébrale maligne chez les patients atteints de douleurs lombaires, » dit resp Nicholas Henschke de l'Institut de santé publique à l'Université de Heidelberg à Heidelberg, en Allemagne. « L'utilisation de ces drapeaux rouges comme déclencheurs pour complément d'enquête conduit à des tests inutiles qui peuvent eux-mêmes être nocifs. »

Seuls sept des 20 drapeaux rouge inclus dans l'analyse ont été évalués à plus d'une étude, en soulignant la nécessité de poursuivre les recherches. « Parce que la colonne vertébrale maligne est rare, nous aurons besoin de voir de très grandes études pour comprendre vraiment si ces drapeaux rouges sont utiles, » a déclaré Henschke. « En particulier, nous aurons besoin de voir des études évaluant des combinaisons de différents drapeaux rouges. Notre examen a porté sur l'exactitude diagnostique des individuels des drapeaux rouges, tandis que dans la pratique, il est plus probable que plusieurs facteurs vont prendre en considération avant une recommandation est faite pour plus amples essais. »

Article adapté par Medical News Today de communiqué de presse original. Cliquez sur « références » onglet ci-dessus pour la source.
Visitez notre section de maux de dos pour les dernières nouvelles sur ce sujet. « Drapeaux rouges pour dépister les tumeurs malignes chez les patients souffrant de douleurs lombaires »,
N. Henschke, Maher CG, Ostelo RWJG, de Vet HCW, Macaskill P, Irwig L.
Cochrane Database of systématique commentaires 2013, 2e édition. Art. N°: CD008686. DOI : 10.1002/14651858.CD008686.pub2. Veuillez utiliser l'un des formats suivants pour citer cet article dans votre essai, le papier ou le rapport :

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« Cancer de la colonne vertébrale : lignes directrices pour le diagnostic non pris en charge chez les Patients atteints de douleurs lombaires »

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Cortisone Injections Can Lead To Necrosis

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Article Date: 02 Jul 2012 - 0:00 PDT Current ratings for:
Cortisone Injections Can Lead To Necrosis

Injections of corticoid preparations can have severe side effects. In this issue of Deutsches Arzteblatt International, Christian Holland and coauthors contribute to physicians' awareness of problems of this type with a report on the relevant findings of medicolegal expert committees in Germany (Dtsch Arztebl Int 2012; 109[24]: 425-30.

One patient, for example, received multiple intramuscular injections of dexamethasone and diclofenac for the treatment of back pain. Six weeks after the last injection, 500 g of necrotic tissue had to be surgically removed from the site of the injections; a subsequent wound infection led to multiple further hospitalizations. The authors describe both aseptic and septic complications, including abscesses and purulent joint infections. When they affect the spine, such complications can cause weakness of varying degrees of severity, ranging all the way to para- or tetraplegia. Fatal sepsis can also occur.

From 2005 to 2009, the German medicolegal expert committees and arbitration panels dealt with 278 cases of complications after corticoid injections. Medical errors were found to have been committed in 40% of cases. Typical errors were faulty asepsis, treatment without indication, and injections that were too closely spaced in time or in excessive doses. Furthermore, whenever it is determined that a patient has not given legally valid informed consent for an injection, the physician is liable for any and all adverse consequences of the injection for the patient's health. By giving physician readers the appropriate knowledge base, the article is intended to help them avoid such difficult medicolegal situations.

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Evidence-Based Guidelines permettent un traitement Optimal de la lombalgie commune

Catégorie principale : Maux de dos
Article Date: 2 octobre 2012 - 2:00 PDT courants nominaux pour :
Evidence-Based Guidelines permettent un traitement Optimal de la lombalgie commune

Alors que les preuves scientifiques montrent que moins est plus quand il s'agit pour le diagnostic et le traitement des douleurs lombaires aux États-Unis, le nombre d'examens d'imagerie coûteuses et chirurgies effectués sur les patients continue d'augmenter, les chercheurs dire.

Plus de 25 pour cent des adultes américains déclarer au moins un épisode de lombalgie aiguë au cours des trois derniers mois et le prix à payer total annuel est environ $100 milliards, selon une étude réalisée dans un numéro du Journal de l'American College of Radiology, en mettant l'accent sur la réforme des soins de santé.

« Pour la grande majorité des patients, vous les regarder étroitement pour un mois, utilisation des mesures conservatrices et ils ont tendance à faire beaucoup mieux à un coût sensiblement moindre, » a déclaré le Dr Scott E. Forseen, neuroradiologue au Collège médical de Géorgie à Georgia Health Sciences University et auteur de l'étude. « Les études montrent aussi qu'une fois que vous cherchez d'imagerie, comme une étude de résonance magnétique, vous êtes plus susceptibles de demander aussi un type d'intervention chirurgicale ». En fait, les taux d'intervention chirurgicale au dos aux Etats-Unis sont environ 40 pour cent plus élevé que dans les autres pays développés.

Prévu et co-auteur Dr Amanda S. Corey, un neuroradiologue à l'hôpital de l'Université Emory à Atlanta, mis en place un ensemble de diagnostic et des directives de traitement basés sur l'écrasante preuve qu'images High-Tech et chirurgies arrière n'améliorent les résultats pour la plupart des patients.

Les exceptions incluent les drapeaux rouges nouveaux maux de dos, comme chez un patient de cancer du sein, où il pourrait être le signe que du cancer s'est propagé ; un patient présentant une fièvre, ce qui indique une infection importante est à blâmer ; chez les personnes âgées, où l'ostéoporose peut entraîner des fractures de compression qui peuvent paralyser ; ou suivant un traumatisme. Mais pour la plupart des gens avec une séance occasionnelle d'une lombalgie non-spécifique, même avec un nerf qui l'accompagne douleur, engourdissement picotement et muscle, observer attentivement ainsi que des analgésiques en vente libre et l'activité physique ciblée, tout médecin doit commander, peut-être prévu. Si le problème persiste au-delà de quatre semaines, les autres mesures, y compris l'imagerie, peuvent être bénéfiques.

Ces types de guides de pratique clinique fondée sur des preuves sont une caractéristique de la réforme des soins de santé et entraînement le paiement et pratique future. Tandis que beaucoup liés à des organisations professionnelles, comme l'American Pain Society et l'American College of Physicians, ont publié des lignes directrices relativement uniforme, le diagnostic et le traitement des douleurs lombaires aux États-Unis reste incompatible, avec peu de consensus parmi les médecins au sujet de ce qui ne fonctionne pas.

Prévu et Corey ont travaillé pour les meilleures pratiques les rendre facilement accessibles aux médecins dans divers milieux de pratique. Les outils de support de décision peuvent être intégrés, par exemple, un système qui envoie un rappel discret des meilleures pratiques ou encore des médecins de blocs d'ordonner des tests jugés inappropriés, dit prévu.

"Un médecin veut commander une IRM lombaire pour un patient souffrant de douleurs lombaires et le dossier médical électronique répondra : Veuillez noter que pour des douleurs lombaires non spécifiques mesures conservatrices et aucune image sont recommandés," prévue a dit. Quelques apps même tirer vers le haut les études originales sur lesquelles reposent les lignes directrices. Sur l'autre extrémité du spectre, l'information peut être convertie en un diagramme simple. Certaines compagnies d'assurance sont dispense déjà leurs exigences pré-autorisation pour tests coûteuses comme une IRM, quand ces guides de pratique clinique fondée sur des preuves sont observées.

« Ce sont des examens coûteuses », prévu a dit de l'IRM, ce qui peut coûter plusieurs milliers de dollars. "C'est une chose de faire un examen coûteux qui pourrait changer votre vie, mais les données ne montrent pas qu'imaging tôt affecte le résultat de la majorité de ces patients. Cependant, il considérablement affecte le coût. » Comme un neuroradiologue, prévu est un promoteur d'imaginer approprié et présenteront un drapeau rouge, MRI est considéré comme le meilleur outil d'imagerie initial, dit-il.

Causes courantes d'une lombalgie incluent l'estomac fragile et retour des muscles, l'obésité, l'inactivité, assis pendant de longues périodes à des postes de travail ou tout simplement le faux mouvement aléatoire. « Vous pencher et frapper cet angle droit et sentez un pincement au coeur, » a déclaré prévu. Sur l'autre extrémité du spectre, les claquages musculaires résultant d'une activité physique intense peuvent être le coupable. Notes prévu il sont sans effets secondaires connus pour une IRM, sauf un opacifiant pour améliorer les images. Les études qui utilisent de gros aimants pour produire des images, impossible d'effectuer sur les personnes avec des dispositifs implantés tels que les stimulateurs cardiaques.

Article adapté de nouvelles médicales aujourd'hui du communiqué de presse original. Source : Georgia Health Sciences University
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First Study To Show Early Brain Changes Predict Which Patients Develop Chronic Pain

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Main Category: Back Pain
Also Included In: Pain / Anesthetics;  Neurology / Neuroscience
Article Date: 03 Jul 2012 - 0:00 PDT Current ratings for:
First Study To Show Early Brain Changes Predict Which Patients Develop Chronic Pain

When people have similar injuries, why do some end up with chronic pain while others recover and are pain free? The first longitudinal brain imaging study to track participants with a new back injury has found the chronic pain is all in their heads - quite literally.

A new Northwestern Medicine study shows for the first time that chronic pain develops the more two sections of the brain - related to emotional and motivational behavior - talk to each other. The more they communicate, the greater the chance a patient will develop chronic pain.

The finding provides a new direction for developing therapies to treat intractable pain, which affects 30 to 40 million adults in the United States.

Researchers were able to predict, with 85 percent accuracy at the beginning of the study, which participants would go on to develop chronic pain based on the level of interaction between the frontal cortex and the nucleus accumbens.

The study is published in the journal Nature Neuroscience.

"For the first time we can explain why people who may have the exact same initial pain either go on to recover or develop chronic pain," said A. Vania Apakarian, senior author of the paper and professor of physiology at Northwestern University Feinberg School of Medicine.

"The injury by itself is not enough to explain the ongoing pain. It has to do with the injury combined with the state of the brain. This finding is the culmination of 10 years of our research."

The more emotionally the brain reacts to the initial injury, the more likely the pain will persist after the injury has healed. "It may be that these sections of the brain are more excited to begin with in certain individuals, or there may be genetic and environmental influences that predispose these brain regions to interact at an excitable level," Apkarian said.

The nucleus accumbens is an important center for teaching the rest of the brain how to evaluate and react to the outside world, Apkarian noted, and this brain region may use the pain signal to teach the rest of the brain to develop chronic pain.

"Now we hope to develop new therapies for treatment based on this finding," Apkarian added.

Chronic pain participants in the study also lost gray matter density, which is likely linked to fewer synaptic connections or neuronal and glial shrinkage, Apkarian said. Brain synapses are essential for communication between neurons.

"Chronic pain is one of the most expensive health care conditions in the U. S. yet there still is not a scientifically validated therapy for this condition," Apkarian said. Chronic pain costs an estimated $600 billion a year, according to a 2011 National Academy of Sciences report. Back pain is the most prevalent chronic pain condition.

A total of 40 participants who had an episode of back pain that lasted four to 16 weeks - but with no prior history of back pain - were studied. All subjects were diagnosed with back pain by a clinician. Brain scans were conducted on each participant at study entry and for three more visits during one year.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our back pain section for the latest news on this subject. Other Northwestern authors on the paper include lead author Marwan N. Baliki, Bogdan Petre, Souraya Torbey, Kristina M. Herrmann, Lejian Huang and Thomas J. Schnitzer.
The study was funded by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health grant NS35115.
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Interventional Radiology Treatments Coming For Weight Loss, Disc Disease

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Main Category: Obesity / Weight Loss / Fitness
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Article Date: 27 Mar 2012 - 2:00 PDT Current ratings for:
Interventional Radiology Treatments Coming For Weight Loss, Disc Disease

A minimally invasive treatment may target hunger at its source, another uses X-ray visible embolic beads to block arteries to the stomach and suppress hunger and a third explores the use of stem cells to repair vertebral disc degeneration. Initial results from all these studies were reported at the Society of Interventional Radiology's 37th Annual Scientific Meeting in San Francisco, Calif.

Approximately 127 million Americans (or 65 percent) are overweight, obese or morbidly obese, according to the Centers for Disease Control and Prevention. The rate of morbid obesity is also rising rapidly. Two new studies that explored the use of proven interventional radiology treatments in new ways may have the potential to help individuals with morbid obesity.

"Currently, there are three clinically viable surgical alternatives for obesity: gastric bypass surgery, gastric pacing and endoscopic gastric banding. These procedures have varying success rates; they are invasive, require extensive gastric/bowel reconstruction or external devices and can have significant surgical complications," explained Charles Y. Kim, M.D., assistant professor of radiology at Duke University Medical Center in Durham, N.C., and lead investigator on one of the studies.

"Our promising results led us to believe that a minimally invasive interventional radiology treatment - called bariatric arterial embolization - would allow for precise targeting of a specific portion of a person's stomach in order to decrease production of ghrelin, a hormone that causes hunger. This treatment could one day be the answer for those who have not been successful with weight loss through diet and exercise," said Kim.

Embolization is a minimally invasive technique where an interventional radiologist uses a thin catheter to inject tiny particles into an artery supplying the area being treated with the goal of blocking tiny vessels to starve it of its blood supply.

"Interventional radiologists have safely and effectively used embolization in many other disease states for decades," stated Kim. "For this study, we selectively blocked and decreased the blood flow to a very specific part of the stomach using specialized radiologic equipment, which led to significantly decreased levels of ghrelin in the animals that we treated. We found that when ghrelin levels decrease, appetite and hunger also decrease, causing weight loss in the treated animals relative to non-treated animals," Kim continued. "Bariatric arterial embolization may have a future use in treating obesity in humans by significantly suppressing appetite to achieve weight loss," he said.

The researchers will continue studies aimed at the reduction and elimination of complications, such as stomach ulcers, and expressed confidence that bariatric arterial embolization is very close to moving toward the clinical trial phase in the United States.

A second study tested a new type of X-ray-visible embolic bead in bariatric arterial embolization.

"Until now, clinically available embolic beads have not been visible on X-ray during or after delivery. We developed a new embolic bead that can be seen directly by X-ray imaging and have tested them in the new bariatric embolization treatment for obesity," explained Clifford R. Weiss, M.D., assistant professor of radiology at Johns Hopkins University, School of Medicine in Baltimore, Md.

"The current system requires that the beads be mixed with X-ray-visible contrast agents before delivery. Although this mixture is visible during infusion, the contrast immediately washes away, and the location of the beads can no longer be 'tracked,'" Weiss said. "By making the beads X-ray visible and using them in tandem with C-arm cone-beam CT - a new way of X-ray imaging that creates 3-D pictures - these beads can be tracked both during and after delivery. This allows for more precise assessment of 'on-target' embolization," he said. "Due to the fact that these beads are visible and can be tracked over time, we should be able to assess their long-term presence. If needed, the patient can then be retreated. With the current clinically available beads, it is not possible to determine whether they are intact and functional over time. We recommend further studies to prove the beads' safety over time and ensure they do not have any unintended effects on the target organs or on the individuals being treated," he added. "We believe there are myriad possible applications for these beads, such as treating cancer of the liver or non-cancerous uterine masses," stated Weiss.

In a third study, a research team showed in animals that stem cells can be injected using only a needle, under X-ray guidance, into degenerated, painful intervertebral discs and initiate their repair.

"Even though 80 percent of people will have painful degenerated discs by age 65 and degenerated intervertebral discs are a significant contributor to low back pain, effective therapies are lacking. The current treatment is surgical removal of these damaged discs, and this often requires more than one surgical procedure. Interventional radiologists acted on a need for a minimally invasive treatment that could mean faster recovery and less need for repeat surgeries in individuals suffering from debilitating disc disease," explained J. David Prologo, M.D., an interventional radiologist at University Hospitals Case Medical Center in Cleveland, Ohio.

"Stem cell therapies are increasingly showing great promise for disc regeneration and biological repair and may represent a promising alternative to destroying the disc, replacement or immobilization," noted Prologo. "All adults have stem cells that can be isolated from their bone marrow, and we observed that repair could be achieved by injecting a person's own stem cells into the bad discs," said Prologo. "After attaching an imaging agent to the injected cells, we were able to prove accurate delivery and containment of those cells at the desired site of action. And, we are now performing the first in human trials of this technique," he added.

"The use of interventional radiology for the delivery of regenerative therapies, such as stem cells, can lead to other minimally invasive procedures associated with potential symptom relief and decreased cost and complications associated with open surgery," Prologo stated. "This research may serve as a precedent for a wide variety of stem cell applications in humans through interventional radiology," he said.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our obesity / weight loss / fitness section for the latest news on this subject. Abstract 2: "Percutaneous Image-guided Transplantation of Human Mesenchymal Stem Cells for the Treatment of Symptomatic Degenerated Intervertebral Discs," J.D. Prologo, department of radiology, vascular and interventional radiology; D. Hart, department of neurosurgery; Z. Love, Z. Lee, department of radiology, all University Hospitals Case Medical Center, Cleveland, Ohio; D. Corn, A. Sattar, L.W. Yuan, N. Tenley, department of biomedical engineering, Case Western Reserve University, Cleveland, Ohio.
Abstract 10: "Bariatric Gastric Arterial Embolization for Modulation of Systemic Ghrelin Levels in a Porcine Model: Endoscopic and Histopathologic Correlation," B.E. Paxton, J. Crow, C. Alley, B. Balmadrid, S. Stinnett, C.G. Keith, R. Kankotia, C.Y. Kim, Duke University Medical Center, Durham, N.C.; A. Arepally, Piedmont Healthcare, Atlanta.
Abstract No. 146: "Gastric Arterial Embolization With X-Ray-visible Embolic Beads and C-arm Cone Beam CT for Increased Accuracy," P.A. DiCamillo, D.L. Kraitchman, radiology; D.L. Kraitchman, molecular and comparative pathobiology; C.R. Weiss, radiology/vascular and interventional radiology, Johns Hopkins University School of Medicine; W. Beh, biomedical engineering; H. Mao, materials science; T. Wang, mechanical engineering, The Johns Hopkins University Whiting School of Engineering, all Baltimore, Md.
SIR 37th Annual Scientific Meeting, March 24-29, 2012.
These abstracts can be found at http://www.sirmeeting.org/
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Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients

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Main Category: Pain / Anesthetics
Also Included In: Alcohol / Addiction / Illegal Drugs;  Fibromyalgia;  Back Pain
Article Date: 01 Jun 2012 - 0:00 PDT Current ratings for:
Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients

Individual use of prescription opioids has increased four-fold since the mid-1990s, in part due to increased awareness of pain control for chronic conditions such as low back pain and fibromyalgia and a Joint Commission mandate that hospitals assess patients' pain as a "vital sign" along with their blood pressure and temperature. During the same timeframe, however, the number of people using these drugs recreationally, becoming addicted to them, and dying of overdoses has also shot up. Today, nearly three quarters of all fatal drug overdoses in the United States are due to prescription drugs - far outnumbering deaths from cocaine and heroin combined, and often outpacing car accidents as the top cause of preventable deaths.

A Perspective piece published online in the New England Journal of Medicine outlines a plan for an "ideal" prescription-drug monitoring program that would enable doctors, dentists, pharmacists, researchers and law enforcement officials to access real-time data on patients' prescription drug histories. The authors, medical toxicologists Jeanmarie Perrone, MD, an associate professor of Emergency Medicine in the Perelman School of Medicine at the University of Pennsylvania, and Lewis S. Nelson, MD, a professor of Emergency Medicine at the New York University School of Medicine, say that such programs would allow physicians to take better care of patients with legitimate pain issues as well as identify and intervene to help potential drug abusers, and cut the number of opioids in circulation for illegal sale.

"As the number of deaths associated with prescription-drug use surpasses the number of fatalities from motor-vehicle crashes in many states, we can learn from the success of auto-safety innovations that have mitigated mortality despite increased automobile use over the past three decades," the authors write. "We should initiate active safety measures to address the growing rates of illness and death associated with the pharmaceuticalization of the 21st century."

The idea of state-run prescription-drug monitoring programs dates back to federal legislation authored in 1993 - long before robust internet use and the development of electronic medical records or e-prescribing systems. Today, 42 states have programs, another six have enacted legislation to develop them, and federal agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration have called for broadening the efforts. But clinician awareness about the tools is poor, and some states, including Pennsylvania, restrict physician access, opening the databases only to law enforcement officials.

The authors note that mounting attention regarding abuse potential of painkillers such as oxycodone and hydrocodone has impaired physician-patient relationships in cases of genuine chronic pain issues. For instance, some recommendations suggest obtaining samples from patients for urine drug screens, or asking them to sign so-called "pain contracts" in which they must agree not to sell or give their drugs away.

To avoid these unintended consequences and improve opportunities to identify and help drug abusers, Perrone and Nelson call for a drug-monitoring system to better inform physician prescribing. Among their recommendations: standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and "doctor shopping" that contributes to illicit use of these controlled substances. They also suggest that the programs include tracking of drugs ranging from those with the most potential for abuse and addiction (oxycodone, for instance) to codeine cough suppressants and stimulant drugs that may be sold or misused for cognitive enhancement.

The authors cite several benefits to more robust drug-monitoring program, including the potential to provide clinicians with an early warning that a patient may need drug counseling or treatment -- and an opportunity to intervene while the patient is still in the medical setting. In addition, they believe these programs could help identify patients who are receiving multiple legitimate prescriptions from different prescribers and pharmacies and may be at risk of polypharmacy complications. As an added benefit, they note that prescribers could use the databases to monitor use of their own Drug Enforcement Administration number to detect forged or stolen prescriptions.

"Although updating an existing prescription-drug monitoring database to incorporate these 'ideal' goals would require additional support and money, the potential to protect the public health is substantial," Perrone says.

Perrone and Nelson will speak this week at the Harold Rogers Prescription Drug Monitoring Program National Meeting in Washington, D.C., where lawmakers will convene to discuss ways to make existing prescription-drug monitoring programs more user-friendly and compliant with health care privacy laws, and strategies to ensure that the data can be shared between states.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject. Please use one of the following formats to cite this article in your essay, paper or report:

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University of Pennsylvania School of Medicine. (2012, June 1). "Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients." Medical News Today. Retrieved from
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posted by No more pain clinic on 24 Aug 2012 at 12:44 pm

Memory of pain caused by injury remained in the brain and it will infact increases the pain sensation substantially .
The patient with pain must be screened by professionals to measure the level of actual pain. By doing such important measurement , the over used drug will be controlled .

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posted by michael wagner on 16 Jul 2012 at 3:18 pm

I believe this is correct:

In My case in the state of Wa. I thought with the new law here That I had to go to a pain specialist, well I do not have to as this law was misused to beniffit the Dr's in the pain and ESI's . I was on a very high amount, and due to the cost i asked my pain specialist if they would reduce my medication due to cost only.
Then again I aked to try another type that was cheaper, but I have been punished for trying one as I had severe side effects, Now I have been dropped 80 % from the time I started with this pain Place. Now I suffer daily, with severe spine problems including arachnoiditis and severe spinal stenios and have had 20 surgerys.

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posted by maryann Lawrence on 20 Jun 2012 at 1:25 pm

When REAL PEOPLE with REAL PAIN conditions have pain they have to suffer due to those who want to make $$$ in illegal sales or to get high. I tell people if I was an animal they would put me out of my misery. I dont even ask for pain meds anymore. I know all about the POTENTIAL for ABUSE or DEPENDENCY. I would trade it all for one day to be pain free. Anything that aids Chronic Pain Patients/ Sufferers live a better quality of life I'm all for it. Do what you must, but the practice of Doctors withholding pain meds is an epidemic. Even my 87 year old mother was denied pain meds until the last weeks of her life. How many people have ended their own lives because some kid down the street is snorting Oxycodone for the buzz. Sorry, Hit a sore spot with me and all I have is Tylenol to take for it.

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posted by Mark Gable on 20 Jun 2012 at 10:49 am

I wholeheartedly agree with this article. But, like an earlier opinion I think the police should be omitted unless the physician brings them in for specific situations. As a chronic pain sufferer I am tired of being the one who suffers because others choose to abuse these medications. I am behind anything that will keep these drugs out of the hands of those who misuse them and still allows pain sufferers to receive the medications needed to treat their pain!

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posted by Tony on 20 Jun 2012 at 6:43 am

The database idea presented would make a lot of sense if the police were eliminnated. Why involve law enforcement for a medical issue, this is actually a violation to a patient's expectation of privacy and also most likely a violation of the Constitution. Doing something for medical reasons to assist a patient is admirable - opening them up to harrassment is aborable. I can clearly see true pain patients being harrassed by police, being pulled over in their vehicles,having their homes invaded for useless searches, etc. Keep the police and all forms of law enforcement out and you have a good idea.

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posted by Brenda on 1 Jun 2012 at 1:07 pm

I think to allow physicians into the database will help them be able to control how much actual prescribtion drugs they give out and of course this will also help the ilegal giving of opids by physicians who tend to forget what a physician actually means.

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'Researcher Calls For Expansion Of Programs To Identify Potential Drug Abusers And Protect Pain Patients'

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Protecting Autoworkers From Back And Shoulder Injury By Tilting Cars On The Assembly Line

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Article Date: 16 May 2012 - 0:00 PDT Current ratings for:
Protecting Autoworkers From Back And Shoulder Injury By Tilting Cars On The Assembly Line

Letting autoworkers sit while they reach into a car's interior could help prevent shoulder and back strain - but another solution might be to tilt the entire car so that workers can stand up.

That's the finding of two recent studies, which tested two ways to protect autoworkers from injury.

Sitting on a cantilevered chair reduced the stress on the workers' backs and shoulders for three common installation tasks. But a different strategy - tilting a car sideways on a carriage so that workers could access the interior while standing - reduced the stress for nine different tasks.

The chair study appears in the July issue of the journal Applied Ergonomics and the carriage study appears in a previous issue.

The car carriage appears to be a better overall option for preventing injuries, explained William Marras, professor and Honda Endowed Chair in the Department of Integrated Systems Engineering at Ohio State University.

"Under these conditions, if you can tilt the car, the chair becomes unnecessary," said Marras, who directs Ohio State's Center for Occupational Health in Automotive Manufacturing (COHAM), where the tests took place.

Honda Motor Co. asked the COHAM team to test the commercially available chair as well as the car carrier, both of which are already used in some of its plants and by other manufacturers around the country.

To use the chair, workers sit on a padded seat at the end of an L-shaped steel beam that is locked into a track above. The "L" slides back and forth as workers use their legs to pull the chair across the floor and into the car.

The researchers tested 10 men and women, five of whom were experienced autoworkers. The other five were college student volunteers, intended to represent first-time, untrained autoworkers. They rode the chair into and out of a car frame while they tightened bolts and installed seat belts, shoulder slides, roof consoles, and dome lights. Wired with sensors to monitor muscle strain, the subjects performed these tasks over a simulated eight-hour workday.

In only three situations - installing the roof console and insulation and tightening bolts in the center of the car - did sitting in the chair reduce loads on the spine and shoulder stress.

The chair didn't help much when workers had to reach the sides or back of the car, either. For installation tasks at the edge of the vehicle, sitting in the chair reduced spine load but did nothing to reduce shoulder stress.

"We thought that sitting down inside the car would make installing the seatbelt easier, but it turned out that you'd need two right hands," said Sue Ferguson, senior research engineer at COHAM and lead author of the study.

Originally, the cantilever chair came with a bucket seat that prevented workers from moving freely. The researchers replaced it with a flat seat and simplified the cantilever system overall. The new design was more practical than the original, and much less expensive: it cost $4,000 to build compared to the original's $100,000.

In the car carriage study, the researchers had 12 people install equipment in a car's interior, underbody, and engine room while standing. They measured stresses on the people's bodies when the car was tilted at different angles.

Of nine different installation tasks, seven became much less strenuous when the car was tilted on its side 45 degrees. The other two showed similar improvements when the car was tilted completely sideways at 90 degrees.

Because of the modification that the researchers made to the seat in the chair study, they began to think about ways to improve seats in general. They are now working with a seat manufacturer to discover more features that make a seat comfortable and functional.

Meanwhile, Honda is using the Ohio State team's discoveries to improve the ergonomics of their factories. In 2007, the company reported that it was able to reduce injuries by 70 percent over five years by adopting these strategies.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our back pain section for the latest news on this subject. Written by Pam Frost Gorder
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posted by Paul H on 16 May 2012 at 3:03 pm

Very interesting, but how much does it cost to tilt a car on an assembly line?

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'Protecting Autoworkers From Back And Shoulder Injury By Tilting Cars On The Assembly Line'

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Brain Imaging Insight Into Cannabis As A Pain Killer

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Main Category: Pain / Anesthetics
Also Included In: Alcohol / Addiction / Illegal Drugs;  Neurology / Neuroscience;  Back Pain
Article Date: 24 Dec 2012 - 1:00 PST Current ratings for:
Brain Imaging Insight Into Cannabis As A Pain Killer

The pain relief offered by cannabis varies greatly between individuals, a brain imaging study carried out at the University of Oxford suggests.

The researchers found that an oral tablet of THC, the psychoactive ingredient in cannabis, tended to make the experience of pain more bearable, rather than actually reduce the intensity of the pain.

MRI brain imaging showed reduced activity in key areas of the brain that substantiated the pain relief the study participants experienced.

'We have revealed new information about the neural basis of cannabis-induced pain relief,' says Dr Michael Lee of Oxford University's Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB).

He adds: 'Our small-scale study, in a controlled setting, involved 12 healthy men and only one of many compounds that can be derived from cannabis. That's quite different from doing a study with patients. My view is the findings are of interest scientifically but it remains to see how they impact the debate about use of cannabis-based medicines. Understanding cannabis' effects on clinical outcomes, or the quality of life of those suffering chronic pain, would need research in patients over long time periods.'

The researchers report their findings in the journal Pain. The study was funded by the UK Medical Research Council and the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre.

Long-term pain, often without clear cause, is a complex healthcare problem. Different approaches are often needed to help patient manage pain, and can include medications, physiotherapy and other forms of physical therapy, and psychological support. For a few patients, cannabis or cannabis-based medications remain effective when other drugs have failed to control pain, while others report very little effect of the drug on their pain but experience side-effects.

'We know little about cannabis and what aspects of pain it affects, or which people might see benefits over the side-effects or potential harms in the long term. We carried out this study to try and get at what is happening when someone experiences pain relief using cannabis,' says Dr Lee.

The Oxford research team carried out a series of MRI scans with each of the 12 volunteers at the FMRIB centre in Oxford.

Before a scan, participants were given either a 15mg tablet of THC or a placebo. THC, or delta-9-tetrahydrocannabinol, is the active psychotropic compound in cannabis - the ingredient that's responsible for the high that drives recreational use of the drug.

To induce a certain level of pain, the volunteers also had a cream rubbed into the skin of one leg. This was either a dummy cream or a cream that contained 1% capsaicin, the ingredient of chillis that causes a hot, burning and painful sensation.

Each participant had four MRI tests to cover each combination of THC or placebo, and chilli pain-inducing cream or dummy cream.

'The participants were asked to report the intensity and unpleasantness of the pain: how much it burned and how much it bothered them,' says Dr Lee. 'We found that with THC, on average people didn't report any change in the burn, but the pain bothered them less.'

While this average effect was statistically significant, there was great variability among the participants in THC's effect on the pain they experienced. Only six out of the 12 reported a clear change in how much the pain bothered them, for example.

The brain imaging results substantiate the reports of the participants. The change in unpleasantness of pain was matched with a suppression of activity in the part of the brain called the anterior mid-cingulate cortex. This structure sits in a deep part of the brain and is involved in many functions, and has previously been implicated in the emotional aspects of pain.

There were also changes in activity of the right amygdala that correlated with the lessening in the unpleasantness of the pain with THC. It is already known that the right side of the amygdala can be 'primed' by pain.

Of most interest to the researchers, however, was the strength of the connection in individuals between their right amydala and a part of the cortex called the primary sensorimotor area. The strength of this connection in individual participants correlated well with THC's different effects on the pain that that volunteer experienced.

This is suggestive that there might be a way of predicting who would see benefits from taking cannabis for pain relief.

'We may in future be able to predict who will respond to cannabis, but we would need to do studies in patients with chronic pain over longer time periods,' says Dr Lee.

He adds: 'Cannabis does not seem to act like a conventional pain medicine. Some people respond really well, others not at all, or even poorly. Brain imaging shows little reduction in the brain regions that code for the sensation of pain, which is what we tend to see with drugs like opiates. Instead cannabis appears to mainly affect the emotional reaction to pain in a highly variable way.'

Dr Michael Lee says: 'Living with chronic pain involves more than just coping with the pain. It runs through your life, through your decisions and what you're motivated to do. Some people might have a known cause for the pain - MS, cancer or an injury - but many others may have no specific cause or diagnosis for their lower back or neck pain, abdominal pain, headaches or other symptoms. That can be very difficult to accept and it can be difficult to treat.

'It is impossible to recommend one single treatment, especially when there are so few therapies for intractable pain. It needs a combined approach that can involve painkillers, exercise and physiotherapy, counselling, even surgery.

'Drugs may be able to relieve the pain somewhat, or offer some comfort. But healthcare should be more than that. It should be about comfort, but also improving quality of life and enabling patients to do more. We need to learn more about pain drugs and their long-term effects. If we can identify how the brain responds to such drugs, we can be more confident about any benefits they may have. It is that which has motivated this study.'

The group initially recruited 15 men to the study. However, data from 2 volunteers was excluded when it became clear they had used cannabis before. One participant experienced THC-induced claustrophobia which meant he could not go in the MRI scanner. His symptoms passed in a number of hours. Women were not included in the study because hormones associated with the menstrual cycle may have influenced experiences of pain over the course of the 4-6 week study.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject. The paper 'Amygdala activity contributes to the dissociative effect of cannabis on pain perception' by Michael C. Lee, Markus Ploner, Katja Wiech, Ulrike Bingel, Vishvarani Wanigasekera, Jonathan Brooks, David K. Menon, Irene Tracey (DOI: 10.1016/j.pain.2012.09.017) will appear in PAIN®, Volume 154, Issue 1 (January 2013) published by Elsevier.

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Patients With Low Back Pain Benefit From Advice To Stay Active

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Catégorie principale : Maux de dos
Également inclus dans : Douleur / anesthésiques ;  Neurologie / Neuroscience
Article Date: 7 août 2012 - 9:00 PDT courants nominaux pour :
Les patients à faible retour douleur prestation de conseils pour rester actif

L'édition du 1er août de la colonne vertébrale des rapports que les conseils sur la façon de rester active pour les travailleurs qui sont en congé de maladie en raison de douleurs lombaires, peuvent augmenter leurs chances de retourner au travail.

Les chercheurs Marc Du Bois, MD et Peter Donceel, PhD, de l'Université catholique de Louvain en Belgique, a déclaré : "Combiné évaluation de counseling et d'invalidité par un conseiller médical fait un rendement plus élevé pour travailler les taux en raison d'une récurrence de congé de maladie inférieure comparativement à évaluation du handicap seule."

L'équipe a recruté 506 travailleurs, principalement cols bleus, qui étaient des médecins quittent à cause de douleurs lombaires et qui ont été évalués régulièrement par un médecin-conseil dans le cadre du belge, santé et invalidité assurance plan national.

L'équipe répartit au hasard les travailleurs en deux groupes. Un groupe a reçu l'évaluation du handicap standard uniquement, tandis que les autres travailleurs a également reçu et du counseling aux bas du dos douleur selon les meilleures pratiques médicales actuellement disponibles. Il s'agissait en évitant le repos au lit et rester active et continue avec les activités quotidiennes normales autant que possibles couplé avec assurance que la douleur était susceptible de s'atténuer avec le temps. Travailleurs ayant des problèmes plus graves comme la sciatique ne figuraient pas dans l'étude.

Les résultats ont révélé que ceux du groupe de consultation avaient de meilleures chances de finalement déchargé des personnes handicapées et reprendre le travail, avec seulement 4 % des travailleurs qui ne sont pas retournent après qu'un an comparativement à 8 % des personnes ayant reçu seulement l'évaluation de l'invalidité standard. Cette différence est principalement due à des épisodes répétés moins de congé de maladie parmi ceux du groupe de counseling (38 %), contre 60 % dans le groupe d'évaluation uniquement. L'équipe a observé aucune différence considérable dans le montant total de jours de maladie, ou du pourcentage de ceux qui en fin de compte nécessaire chirurgie (10 à 12 %).

Une lombalgie, c'est à dire les maux de dos qui n'est pas causée par une anomalie spécifique est très fréquent et aussi un état de santé très coûteux, et même si la condition est habituellement « auto-limitation » et améliore au fil du temps, de nombreux patients souffrent de longues périodes de douleur qui conduisent à de nombreux traitements et incapacité prolongée. En Belgique uniquement, douleurs lombaires est responsable d'un quart de tous les travailleurs handicapés de la vie.

Récupération peut être retardée et même entravée par le biais de longues absences du travail et de la sédentarité, avec des facteurs psychosociaux joue aussi un rôle dans le risque que la douleur devient un problème chronique. Selon des recherches antérieures, offrant réconfort de la douleur amélioration et indiquer aux travailleurs de rester aussi actif que possible a démontré à réduire le temps hors travail.

Les chercheurs concluent cette information sur le patient et des conseils ainsi qu'une évaluation de routine pour douleurs lombaires peut augmenter le nombre de patients qui retournent à leur lieu de travail, diminution du nombre de personnes qui prétendent de maladie et invalidité. Une « approche axée sur la remise en état » semble être bénéfique dans la diminution du taux de congés de maladie récurrente et doubler les chances de retour au travail dans les mois subséquents.

Du Bois et Donceel croient que ce genre de counseling peut aider à empêcher que la lombalgie devienne une condition chronique, invalidante chez de nombreux patients et soulignent que l'information courante et des conseils doivent être « très tôt », c'est-à-dire dans les six semaines après que le patient se rend en congé médical, « avant que les effets secondaires d'être inscrites par le malade se sont installés. »

Rédigé par Grace Rattue
Copyright : Nouvelles médicales aujourd'hui
Ne doit pas être reproduit sans l'autorisation de nouvelles médicales aujourd'hui

Visitez notre section de maux de dos pour les dernières nouvelles sur ce sujet. « Guider les prétendants de bas du dos au travail : une épreuve commandée randomisée »
Du Bois, Marc MD ; Donceel, Peter, MD, PhD
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