Patients fitted with prosthetic limbs who often experience pain may benefit from a monitoring system in development by engineers at the University of Washington (UW; WA, USA).
The place where an amputee‘s skin meets the socket of their prosthetic can be a source of daily pain, especially in those patients with additional complicating conditions, such as diabetes. Bailey, a patient who lost his leg below the knee, found that the remaining part of his leg shrank in the years following his surgery, causing discomfort where his limb connected to the prosthesis. He was required to use a variety of sockets of different sizes and pieces of fabric to cushion the socket. Bailey commented, “In the end, the socket is the most important part. You can have a great prosthetic foot, but if the socket isn‘t comfortable, you‘re not going to wear it.”
The new device that has been created by the team at the UW is designed to ease the discomfort that patients with prosthetic limbs endure. The device tracks the extent of swelling and shrinkage of the limb that naturally happens throughout the day while inside the socket. This swelling can be extremely painful in fixed sockets, and can often only be relieved by patients removing their prosthetic, or by adjusting the fit of the socket. By using the data from this new device, the extent and timing of swelling for individual patients could be analyzed, allowing physicians to fit the most appropriate limbs, resulting in minimization of pain.
“This provides us a window into what‘s happening,” commented Joan Sanders, the principal investigator and professor of bioengineering at UW. “I‘m really encouraged by what we have so far. Each person has his or her own characteristics and qualities that affect how limb volume changes. You really have to look at each person on a case-by-case basis.”
The fluid volume in a patient‘s limb is recorded by the device via electrodes, and the data is then analyzed and stored within the device. The prototype device has been tested in approximately 60 patients, where it measured changes in limb volume during a range of exercises, including sitting, standing and walking. Bailey has had a positive experience from being part of this research, and is now virtually pain free through the use of customized prosthetics.
Researchers are hopeful that they will be able to roll their device out to various clinics, so that patients may benefit from it in the same way as Bailey. In the longer term, they intend to develop a device that can be worn for weeks to collect more detailed data regarding a patient‘s daily routine.
Data from this device may also be utilized to allow scientists to create ‘smarter sockets‘ for prostheses in the future. This includes making them more robust and flexible. One technology that may help researchers achieve this aim is vacuum-suction technology, which can increase comfort and reduce pain.
– Written by Sophie Breeze
Source: University of Washington news and information: www.washington.edu/news/2013/07/23/pain-of-artificial-legs-could-be-eased-by-real-time-monitoring
Analysis from a new study carried out in the pediatric emergency department at the Stollery Children‘s Hospital (Alberta, Canada) indicates that children who were listening to music experience less pain and distress than those not exposed to music.
In the trial, 42 children (all between 3 and 11 years old) who were admitted to the pediatric emergency department at the Stollery Children‘s Hospital and needed an intravenous drip to be fitted were observed either while listening to music or with no music during the procedure The child‘s distress level, perceived pain level and heart rate were monitored.
The findings from the study, led by Lisa Hartling from the University of Alberta (Alberta, Canada) revealed some interesting trends, “We did find a difference in the children‘s reported pain – the children in the music group had less pain immediately after the procedure,” reports Hartling. “The finding is clinically important and it‘s a simple intervention that can make a big difference. Playing music for kids during painful medical procedures would be an inexpensive and easy-to-use intervention in clinical settings.”
In addition to the children exposed to music reporting less pain, their parents and the healthcare professionals involved were also more satisfied. Interestingly, the heathcare professionals administering the intravenous drip were significantly more likely to report that the procedure was ‘very easy‘ with the children who were listening to music.
This research will continue, with Hartling and her team intending to investigate whether music can affect pain in other medical procedures. The team hopes that by reducing the pain and distress associated with medical procedures, children will be less likely to have “long-lasting negative effects”.
“There is growing scientific evidence showing that the brain responds to music and different types of music in very specific ways,” adds Hartling. “So additional research into how and why music may be a better distraction from pain could help advance this field.” Further research into this area may include experimenting with different genres of music, or looking at whether there are lyrics or the patient knows the music. All of these factors may influence the effectiveness of this possible noninvasive analgesic method.
– Written by Sophie Breeze
Sources: University of Alberta news release: www.med.ualberta.ca/news/2013/july/music-decreases-pain-in-kids; Hartling L, Newton AS, Liang Y et al. Music to reduce pain and distress in the pediatric emergency department: a randomized clinical trial. JAMA Pediatr. doi:10.1001/jamapediatrics.2013.200 (2013) (Epub ahead of print).
Research led by scientists at the Icahn School of Medicine at Mount Sinai (NY, USA) has resulted in the discovery of a compound that appears to be as effective as opioid pain medications but without the associated dependence or side effects.
While morphine is widely used as an analgesic in cases of severe pain, the associated side effects, such as tolerance, dependence, respiratory issues, constipation and diarrhea, mean that scientists are keen to find alternative pain treatments.
A new compound, CYM51010, discovered by Lakshmi Devi‘s team at Mount Sinai, can target a protein complex with both µ- and δ-opioid receptors. The protein complex that it targets, known as a GPCR heteromer, was identified by Devi‘s team as a possible therapeutic target for pain relief. The GPCR heteromer can be found in areas of the brain that process pain, and cause morphine tolerance and side effects.
“GPCR heteromers have been suggested to represent powerful targets for improved, novel therapeutics with reduced adverse effects in people with severe pain,” explains Devi. “However, there are presently no chemical tools that allow us to investigate their role in vivo.”
In the research carried out by Devi‘s team, CYM51010 was found through high throughput screening. Early research suggests that it is as potent as morphine, but appears not to cause the same negative side effects as seen with traditional opioid pain medications. Devi hopes that modified versions of this compound will be able to be used as alternative analgesics in the future.
The binding of CYM51010 to GPCR heteromers is of particular significance, as this knowledge will help in the modification of the compound. Alternative pain relief treatments such as this a-re a priority for researchers. Devi concludes, “Our work represents a promising step in this direction, providing results that pave the way towards a new understanding of the function and pharmacology of opioid receptor heteromers.”
– Written by Sophie Breeze
Sources: Mount Sinai Hospital press release: www.mountsinai.org/about-us/newsroom/press-releases/chemical-compound-shows-promise-as-alternative-to-opioid-pain-relievers; Gomes I, Fujita W, Gupta A et al. Identification of µ-δ opioid receptor heteromer-biased agonist with antinociceptive activity. Proc. Natl Acad. Sci. USA 110(29), 12072–12077 (2013).
A new finger-stick blood sample diagnostic method has been developed by scientists at The Ohio State University (OSU; OH, USA) that can detect fibromyalgia syndrome, a pain disorder that is notoriously difficult to diagnose.
The accurate diagnosis of fibromyalgia can take years, as the symptoms can mimic many other conditions. As such, patients who are finally diagnosed through an elimination process are often in urgent need of treatment. “The importance of producing a faster diagnosis cannot be overstated, because patients experience tremendous stress during the diagnostic process,” reports lead author of the study, Kevin Hackshaw, associate professor of medicine at OSU‘s Wexner Medical Center. “Just getting the diagnosis actually makes patients feel better and lowers costs because of reductions in anxiety.”
This new technique, pioneered by researchers at OSU, may be able to significantly cut down the diagnosis time. The new method involves a high-powered, specialized microscope that is able to recognize molecular patterns in blood-spot samples. It can then analyze this data to distinguish between fibromyalgia, osteoarthritis and rheumatoid arthritis, which all display similar symptoms.
“We‘ve got really good evidence of a test that could be an important aid in the diagnosis of fibromyalgia patients,” commented a senior author of the study, Tony Buffington, who is professor of veterinary clinical sciences at OSU. “We would like this to lead to an objective test for primary care doctors to use, which could then produce a diagnosis as much as 5 years before it usually occurs.”
The infrared microspectroscopy technology used in this method can detect the biochemical content of even small amounts of dried blood. In the preliminary study with this technology, the molecular patterns of fibromyalgia, osteoarthritis and rheumatoid arthritis were scanned and stored by the microscope. This ‘training‘ allowed the microscope to accurately identify each disease.
“It separated them completely, with no misclassifications,” Buffington added. “That‘s very important. It never mistook a patient with fibromyalgia for a patient with arthritis. Clearly we need more numbers, but this showed the technique is quite effective.” Although this technology may be expensive, a central laboratory could be set up in the USA to analyze samples from various medical centers.
– Written by Sophie Breeze
Sources: Hackshaw KV, Rodriguez-Saona L, Plans M, Bell LN, Buffington CA. A bloodspot-based diagnostic test for fibromyalgia syndrome and related disorders. Analyst 138, 4453–4462 (2013); The Ohio State University news: http://medicalcenter.osu.edu/mediaroom/releases/Pages/Faster,-Simpler-Diagnosis-for-Fibromyalgia-May-be-on-the-Horizon-.aspx
Chronic neck pain, resulting from inflamed cervical facet joints, can be an extremely debilitating problem for many people worldwide. Recently, the University of Florida Health Spine and Sports Intervention Center (FL, USA) has begun to use a new device that has alleviated patients‘ pain rapidly. Many patients with chronic neck pain turn to surgery to relieve pain; however, such procedures can be too risky for some patients owing to their age or existing medical conditions. The University of Florida has recently announced that it has been using a new nonsurgical procedure called water-cooled radiofrequency to treat patients, with promising early results.
William Tuten was the first patient treated at University of Florida using the technique and, following the treatment, described his outcome with the procedure, “The result is immediate … You lose the pain before you leave the building.” While radiofrequency does not fix the cause of the chronic neck pain, it can block a patient‘s pain for 6–12 months. In radiofrequency treatment, a small needle is inserted into the problematic cervical facet joint. The needle is connected to a device that delivers radiofrequency energy down the needle; this heats the needle and the nerve it is in contact with. This heat energy stuns the nerve, blocking the pain from the joint. The nerve is only stunned and not destroyed by the procedure as this would result in regrowth, leading to the development of a bundle of nerves, potentially causing more pain than the original nerve.
While this technique has been used for some time, there are a number of benefits provided by the new water-cooled technology used at the University of Florida. Circulating water is used to cool the tube connecting the device to the needle, facilitating better control, both in terms of targeting the needle and the temperature of the needle. William Jacobs, from the University of Florida, who treated Tuten, summarized the benefits of water-cooled devices, “Cooled radiofrequency gives us a perfectly round treatment area, so you consistently know where you‘re treating … It also treats a bigger area at a lower temperature, so you can have it on the nerve for almost twice as long. It‘s more effective for your patient, and will probably last longer.”
Following treatment with the procedure, Tuten found his pain greatly reduced and was able to return to his favorite hobby, fishing, before he began to suffer from chronic pain. He commented on the procedure, “You know you still got a problem there, but it‘s tolerable and you can live with it. It gives people like myself a quality of life that we wouldn‘t have otherwise.”
– Written by Sean Fitzpatrick
Source: University of Florida. New radiofrequency procedure stuns nerves, relieves chronic neck pain longer: http://news.medinfo.ufl.edu/articles/from-the-lab/new-radiofrequency-procedure-stuns-nerves-relieves-chronic-neck-pain-longer
Physicians are often worried about the addictive and abuse-related side effects of using opioids to treat patients suffering from chronic pain. A research team from Duke University (NC, USA) has recently published its early investigations into a potential new strategy for treating chronic pain. The researchers have published their work in a mouse model, detailing the promising early results of a derivative of the main ingredient in over-the-counter fish oil products in the treatment of pain. Their results are published in Annals of Neurology.
The compound that was the focus of the researchers‘ interest is neuroprotectin D1=protectin D1 (NPD1=PD1), which is derived from docosahexaenoic acid, a major ingredient in fish oil supplements. NPD1=PD1 is a bioactive lipid that is produced as a response to external stimuli. Describing the compounds included in the study and the reasons for choosing them, Ru-Rong Ji, principal investigator of the study from Duke University Medical Center, said, “These compounds are derived from omega-3 fatty acids found in fish oil, but are 1000-times more potent than their precursors in reducing inflammation.”
The nerve-injury mouse models used by the researchers simulated pain symptoms that are often associated with nerve trauma occurring as a result of surgery. The mice were then treated with either locally administered NPD1=PD1, or NPD1=PD1 administered by injection.
They found that NPD1=PD1 resulted in alleviated pain; however, it was also found that administration of NPD1=PD1 resulted in reduced nerve swelling following injury. NPD1=PD1 inhibited the production of cytokines and chemokines that would normally attract inflammatory macrophages to the nerve cells. In preventing recruitment of cytokines and chemokines, NPD1=PD1 protects nerves from further injury, and in addition reduces neuronal firing, resulting in the injured animal feeling less pain.
The researchers are confident that, if successful in subsequent trials, the compounds investigated here can yield significant benefits in the treatment of pain, with Ji commenting, “Chronic pain resulting from major medical procedures such as amputation, chest and breast surgery is a serious problem … We hope to test this compound in clinical trials … [docosahexaenoic acid] is very inexpensive, and can be converted to NPD1 by an aspirin-triggered pathway.” These combined factors could lead to this early work having an important impact on the future of chronic pain treatment.
– Written by Sean Fitzpatrick
Sources: Duke University. Uncovering a healthier remedy for chronic pain: http://today.duke.edu/2013/07/paindha; Xu ZZ, Liu XJ, Berta T et al. Neuroprotectin/protectin D1 protects neuropathic pain in mice after nerve trauma. Ann. Neurol. doi:10.1002/ana.23928 (2013) (Epub ahead of print).
Promising results from a clinical trial investigating the addition of cognitive–behavioral therapy (CBT) to amitriptyline in controlling migraines in children with near daily headaches have been presented at the International Headache Congress recently.
The trial was a randomized controlled trial that included 135 children suffering from chronic migraine. Patients were randomized to receive either amitriptyline in combination with CBT, or amitriptyline with an educational and supportive program. In subjects randomized to the CBT group, CBT was delivered in weekly sessions for a period of 8 weeks before transitioning to monthly sessions for a period of 3 months. The control program involved education about migraine and general support; it was provided by the same therapists who delivered CBT and lasted for approximately the same amount of time. In both groups, treatment with amitriptyline was phased in, titrated over the first 8 weeks of the study, with the target dose being 1 mg/kg/day; the final mean dose delivered in the study was 1 mg/kg/day. Patient evaluation occurred at week 20 and after 1 year of treatment.
The coprimary end points used in the trial were headache frequency (days measured by 28‑day diary) and migraine-related disability (PedMIDAS). After 20 weeks, the CBT treatment group was found to have reduced the number of monthly headache days by 11.6 compared with 6.7 (p < 0.01) in the other group; headache-related disability rates were also found to be most improved in the CBT group.
The study researchers, led by Scott Powers from Cincinnati Children‘s Hospital (OH, USA), feel that the significant results of the study should very quickly have an impact on clinical practice in the treatment of childhood migraines. Powers outlined that the benefit of CBT in treating migraine was particularly pronounced as the improvements from baseline in the control group in the trial were very similar to those found in adult patients treated with already approved medical therapies botulinum toxin A and topiramate, indicating a significant potential clinical benefit for the inclusion of CBT in treatment.
– Written by Sean Fitzpatrick
Source: Powers SW, Kashikar-Zuck S, Allen J, LeCates S, Rausch J, Hershey AD. Cognitive behavioral treatment plus amitriptyline leads to clinically significant reductions in headache frequency and migraine-related disability: a randomized clinical trial in pediatric chronic migraine. Presented at: 2013 International Headache Congress, Boston, MA, USA, 27–30 June 2013.
The attitude of physicians towards opioid medications has been shown to dramatically affect their tendency to prescribe opioid pain relief medication.
Physicians with negative attitudes towards opioid medications are less likely to prescribe them to their patients for pain relief, according to a new study published by University of Washington (WA, USA) researchers in The Journal of Pain. This finding is no doubt a reflection of the changing attitudes of physicians to changes that have occurred in regulations, public opinions of narcotic pain medications and rising drug misuse.
The questionnaire, which was taken by 1535 physicians in the USA, looked at their stance on medical education, efficacy of opioids, concerns over prescribing opioids and their thoughts on the benefits of tamper-resistant formulations.
Over 70% of the physicians who took the questionnaire reported that they prescribe opioids to less than 30% of their chronic noncancer pain patients. Interestingly, physicians who dealt with high volumes of pain patients were less inhibited about prescribing opioids, were more positive in general about tamper-resistant formulations and less concerned about side effects of opioid therapy.
These results suggest that a lack of experience with treating pain may be linked to an unwillingness to prescribe long-term opioids. Of note, orthopedists were the least likely to prescribe opioids, and showed the most concern over drug efficacy and the possibility of opioid addiction. These data may be used in the development of future pain treatment guidelines and education for physicians.
– Written by Sophie Breeze
Source: Wilson HD, Dansie EJ, Kim MS, Moskovitz BL, Chow W, Turk DC. Clinicians‘ attitudes and beliefs about opioids survey (CAOS): instrument development and results of a national physician survey. J. Pain 14(6), 613–627 (2013).