A study conducted at the Johns Hopkins School of Medicine (MD, USA), has provided findings that suggest that individuals who suffer from episodic migraines (EMs) are more likely to be obese. The results of the study were published in a recent issue of Neurology.
A total of 3862 participants, who had an average age of 47 years, were interviewed in the National Comorbitiy Survey Replication, in which they were asked to disclose their weight, height and how often they suffered from migraines. It was recorded that 188 participants suffered from EMs or occasional migraines. It was calculated that the risk of EMs were 81% greater in individuals who were obese compared with those of normal weight. The team also observed that there was a significant trend of increasing risk of EMs with increasing obesity status from normal weight to overweight to obese. By performing stratified analyses, the researchers demonstrated that the risk of EMs increased in obese individuals in comparison with individuals of normal weight, those younger than 50 years of age or of female gender.
Study author, Lee Peterlin from Johns Hopkins School of Medicine, corresponded with Future Neurology, speaking of the unique nature of the study: “In contrast to some of the previous studies, looking at this association in this study, we were able to exclude remitted migraineurs and nonmigraine headache participants from the control group, which may have contributed to our ability to detect this association.”
This study concluded that obesity be an underlying risk factor for an increased frequency of EMs. Clinicians can, therefore, take this observation into consideration and offer their patients advice that involves modifying lifestyle choices including regular exercise and following a healthy diet. Peterlin spoke of the future implications of the study expressing that the results “should stimulate further research as to the efficacy of weight loss therapies for migraine prevention.”
– Written by Simi Thankaraj
Source: Peterlin LB, Rosso AL, Williams MA et al. Episodic migraine and obesity and the influence of age, race, and sex. Neurology 81(15), 1314–1321 (2013).
Research carried out at St George‘s, University of London (UK) has given new hope to the possibility that a drug usually taken by osteoporosis sufferers may have the potential to provide pain relief in patients suffering with knee and hip osteoarthritis.
Osteoporosis is a rheumatic disease characterized by fragile bones that is also often very painful. The joint condition results in bony growths, cartilage damage and sore tissue. Nidhi Sofat, senior researcher of the recent study, commented that, “Osteoarthritis is the most common form of arthritis worldwide. It causes damage to bone and cartilage in the joints of affected people. Most treatments are focused around pain relief, as no robust treatments have been discovered that slow down the progression of the disease.”
Bisphosphonates are commonly prescribed to patients with osteoporosis, as they have the ability to change the structure of bone. There has been speculation for some time that bisphosphonates could also be used to reduce joint pain and discomfort in patients with osteoarthritis. Researchers at St George‘s, led by Sofat, looked at past studies in patients being treated with a variety of bisphosphonates for hand, knee, spine or hip osteoarthritis.
Sofat expains, “Our study looked at whether there were any bisphosphonate drugs that have been shown to influence pain and/or disease progression that could be used in osteoarthritis treatment.” The researchers found that, out of 3832 patients studied, most bisphosphonate drugs provided limited pain relief.
Despite this disappointing general finding, some specific forms of bisphosphonates did appear to have some effectiveness at managing pain associated with osteoarthritis. Specifically, the use of zoledronate and alendronate for 6 months appears to improve knee and hip osteoarthritis. In addition, alendronate may even be more effective than existing pain relieving drugs for the relief of pain relating to hip osteoarthritis.
“More research needs to be carried out to determine which patients could benefit most from this type of intervention,” Sofat concludes. “Osteoarthritis is a long-term chronic condition, so it is essential that we work to understand whether the use of these medicines in the long term could be tolerated.”
– Written by Sophie Breeze
Sources: St George‘s, University of London news: www.sgul.ac.uk/media/latest-news/bisphosphonates-could-offer-effective-pain-relief-in-osteoarthritis-research-finds; Davis AJ, Smith TO, Hing CB, Sofat N. Are bisphosphonates effective in the treatment of osteoarthritis pain? A meta-analysis and systematic review. PLoS ONE 8(9), e72714 (2013).
Dementia and stoicism are identified as potential barriers to effective long-term pain management in an article recently published in the journal Nursing Older People.
The inability, or unwillingness, of patients to communicate their pain to care workers owing to sensory (i.e., hearing and vision deficit) or cognitive (i.e., delirium and dementia) impairment could lead to patients being at risk of suboptimal treatment. The study of nurses working in care homes in Ireland noted that a significant barrier to providing appropriate pain relief is caused by patient attitudes, including patients trying to hide their pain.
Pain relief can only be given when caregivers are aware of a patient‘s pain, and so the researchers commented, “It is therefore essential that patients are encouraged to verbalize their pain to family and care staff.”
Another barrier to pain management identified in the study was misunderstandings on the part of caregivers when observing the behavior of some patients, in particular in patients suffering from dementia. For example, care staff may mistake behavior caused by pain as behavior caused by dementia itself, leading to the inappropriate prescription of antipsychotic medication.
In order to overcome the barriers identified in the study, the researchers suggest that all caregivers working in long-term care facilities should be in a program of ongoing education on pain. They emphasize that caregivers should be specifically trained to treat and diagnose pain in patients suffering from dementia, utilizing observational tools such as the Abbey pain scale.
– Written by Sophie Breeze
Sources: AlphaGalileo Foundation news: www.alphagalileo.org/ViewItem.aspx?ItemId=134569&CultureCode=en; Egan M, Cornally N. Identifying barriers to pain management in long-term care. Nurs. Older People 25(7), 25–31 (2013).
A novel compound developed by the University of Maryland (UMD) School of Pharmacy (MD, USA) has demonstrated that it is equally as powerful as morphine while exhibiting diminished tolerance and no toxic effects in initial studies.
The new opioid compound, named UMB 425, shows the potential to be developed as a pain relief medication, and could improve the quality of life of individuals with chronic pain.
Andrew Coop, chair of the Department of Pharmaceutical Sciences at the UMD School of Pharmacy, explains the mechanism behind the novel drug, “UMB 425 is a breakthrough in the development of therapeutics to treat chronic pain. Unlike other drugs developed to act on only one biological target, UMB 425 acts on two different opioid receptors in the body. When activated at the same time, these receptors work together to provide pain relief and slow the body‘s development of tolerance to the drug. This diminished tolerance allows a lower dose of the opioid to be administered for a longer time period, while still achieving the same level of pain relief.”
Opioids are commonly prescribed to patients suffering from chronic pain conditions. However, as tolerance increases, so must the dose to achieve the same level of pain relief, often leading to dependence, and side effects such as constipation, drowsiness, nausea and dizziness.
“The clinical implication of this research has the potential to be tremendous,” adds Mary Lynn McPherson, professor at the UMD Department of Pharmacy Practice and Science. “If clinicians can prescribe lower doses of opioids, they will not have to raise a patient‘s dose because of tolerance to the analgesic effects. Using lower doses will result in less severe adverse effects for the patient, both short-term effects such as nausea and constipation, as well as long-term adverse effects on the endocrine and immunologic systems. This would be a highly significant advance in pain management.”
Coop intends to continue experiments with UMB 425, aiming to develop two compounds from UMB 425 to enter into Phase I clinical trials in the future.
– Written by Sophie Breeze
Sources: Healy JR, Bezawada P, Shim J et al. Synthesis, modeling, and pharmacological evaluation of UMB 425, a mixed µ agonist/δ antagonist opioid analgesic with reduced tolerance liabilities. ACS Chem. Neurosci. 4(9), 1256–1266 (2013); SOP faculty develop new, promising compound for treatment of chronic pain: https://rxsecure.umaryland.edu/apps/news/story/view.cfm?id=381&CFID=1149936&CFTOKEN=67ee1c74817e36ba-EC9CFBCF-FDC6–2973-CE1D3C095AC564CC
Researchers at Northwestern University (IL, USA) have discovered that structural differences in the white matter of a person‘s brain can affect their susceptibility for chronic low back pain.
Chronic pain is an enormous burden on healthcare systems worldwide, and with chronic low back pain accounting for a large percentage of reported pain conditions, further research into possible causes and treatments is highly desirable. Traditionally, the cause of chronic pain was believed to be at the site of injury; however, the team at Northwestern University, led by senior author Vania Apkarian, were interested in looking at the potentially critical role the brain plays in the development and maintenance chronic pain.
In the study, the brains of 46 participants who had low back pain for 3 months, but no pain previously for at least 1 year, were scanned using a technique called diffusion tensor imaging (DTI). DTI can measure the structure of white matter, including the axons connecting different parts of the brain. Over the course of the study, which lasted for a year, approximately half of the patients recovered, while the other half had pain throughout the study, which was categorized as persistent. Analysis of the DTI scans revealed that there were consistent differences in the structure of the white matter between patients that recovered and those with persistent pain.
Apkarian commented, “Our results suggest that the structure of a person‘s brain may predispose one to chronic pain.” In support of this theory, the researchers also noted that the white matter structure of patients with persistent pain resembled DTI scans of patients known to suffer from chronic pain. In addition, the DTI scans of those that recovered from low back pain showed a similar white matter structure to healthy control subjects.
Interestingly, when using this information and looking back at the initial white matter DTI scans of the study participants, the researchers were able to predict to an accuracy of approximately 80% whether the participants would recover or experience persistent pain.
They were able to do this by further analysis of the DTI brain scans, specifically looking at the white matter structure connecting the nucleus accumbens and the medial prefrontal cortex. These two regions are believed to be involved with pain, and showed the greatest differences between the subjects who recovered and those who had persistent pain.
“We were surprised how robust the results were and amazed at how well the brain scans predicted persistence of low back pain,” concludes Apkarian. “Prediction is the name of the game for treating chronic pain. Our results support the notion that certain brain networks are involved with chronic pain. Understanding these networks will help us diagnose chronic pain better and develop more precise treatments.”
– Written by Sophie Breeze
Sources: Mansour AR, Baliki MN, Huang L et al. Brain white matter structural properties predict transition to chronic pain. Pain 154(10), 2160–2168 (2013); National Institute of Neurological Disorders and Stroke press release: www.ninds.nih.gov/news_and_events/news_articles/pressrelease_brain_chronic_pain_09172013.htm
The first randomized, placebo-controlled study was created in order to reveal the benefits of using arginine therapy in children diagnosed with sickle cell disease that have been hospitalized due to severe pain. The results seem to suggest that arginine therapy could be a potential inexpensive and safe therapy for the episodes of acute pain that are suffered by patients with sickle cell disease. The first author on the study was Claudia Morris (Emory University School of Medicine, Atlanta, GA, USA) explained the need for a therapy for the pain associated with the condition, “Episodes of pain due to vaso-occlusion are the leading cause of hospital admission and emergency room visits and are associated with increased mortality, yet there is no effective therapy targeting the underlying cause.” She went on to say, “Treatment consists only of symptom relief with pain medicines and hydration. There is an urgent need for new therapies for acute sickle cell pain, and a greater than 50% reduction in use of opioid pain medication was a remarkable finding.”
Sickle cell disease, an inherited condition can lead to the blockage of blood within the smaller vessels of the body which in turn can lead to both severe pain as well as organ damage.
Arginine can be found both as part of the diet as well as via nutritional supplement. The authors of the current study had previously shown that during a pain episode children suffering from sickle cell disease had an acute arginine deficiency. Those children who had to be hospitalized as a result of the pain were shown to possess the lowest arginine levels. As nitric oxide levels have also been shown to be deficient in sickle cell disease and arginine is a building block of nitric oxide, the hypothesis by researchers is that arginine could be a potential treatment for the pain associated to the disease.
Prior research by the investigators also showed how one single dose of arginine administered to patients diagnosed with sickle cell disease as well as the associated acute pain episodes showed an apparent significant dose-dependant increase in levels of plasma nitric oxide concentration. Using this previous study-related knowledge the current study enrolled 38 children diagnosed with sickle cell disease who had been hospitalized for a total of 56 episodes of pain related to the condition. With the aid of arginine the results demonstrated that there was a reduction of 54% decrease in the use of opioid-based pain medications and lower pain scores were noted when the children were discharged from the hospital in comparison to those who had received placebo.
The study also highlighted the apparent lack of safety problems when using arginine. Use of arginine did not significantly reduce the length of stay in the hospital but there was a decrease of approximately 17 h in the arginine-treated group. However, researchers believe that if the drug was delivered earlier, as soon as possible this may impact the length of stay more significantly. The researchers also note that a larger multicenter trial is required to both confirm the observations seen as well as test what effects come from delivering the arginine therapy earlier.
– Written by Priti Nagda
Sources: Morris CR, Kuypers FA, Lavrisha L et al. A randomized, placebo-controlled trial of arginine therapy for the treatment of children with sickle cell disease hospitalized with vaso-occlusive pain episodes. Haematologica 98(9), 1375–1382 (2013); Emory Health Sciences, Emory new center: http://news.emory.edu/stories/2013/09/arginine_therapy_for_sickle_cell_pain