A saline injection in the spine could be more effective than steroids for treating lower back pain, a new study has revealed.
Spinal pain is a leading cause of disability in the industrialised world and epidural steroid injections - the most common nonsurgical treatment - have been the standard treatment for more than 50 years.
Yet the alternative spinal injection in the space around the spinal cord may provide better relief than steroids which can have adverse side effects.
Steroids raise blood sugar in diabetic back patients, slow the healing of wounds and accelerate bone disease in older women, the Johns Hopkins University study found.
Professor of Anaesthesiology Steven Cohen at the U.S. university said: 'Just injecting liquid into the epidural space appears to work.
'This shows us that most of the relief may not be from the steroid, which everyone worries about.'
The research was prompted when more than 740 people in 20 U.S. states became ill with fungal meningitis and 55 people died after getting epidural injections of contaminated steroids last year.
Although better oversight might reduce that risk, patients can only get a limited number of steroid injections each year, even if their pain returns.
Professor Cohen said it was too soon to recommend that patients stop receiving epidural steroids, but added that their analysis also suggests that smaller steroid doses can be just as beneficial.
Fellow researcher Dr Mark Bicket said larger scale studies were needed to determine whether steroid alternatives can be just as helpful for back pain patients.
He said: 'Our evidence does support the notion that, for now, reducing the amount of steroids for patients at risk may be advisable.'
The review covered medical records of 3,641 patients from 43 studies conducted in October 2012 and compared epidural steroid injections to other sorts of epidural and intramuscular injections.
Professor Cohen said the new analysis suggested that decades of mixed results of research on epidural steroid injections may have been due to the use of saline or anaesthetic injections as the comparison 'placebo' treatment.
He said: 'It's likely that those studies were actually comparing two treatments, rather than placebo versus treatment. Researchers may be wasting millions of dollars and precious time on such studies.'
The findings are published in the latest edition of the journal Anaesthesiology.
http://www.dailymail.co.uk/health/article-2424521/How-salt-jab-effective-lower-pain-steroids.html
Pain and its Meanings - Wellcome Collection
Is pain really so difficult to articulate? Or can it actually generate creative expression? If so, what do these narratives tell us about the meaning of pain? Some believe it has the power to purge sin; others interpret it as an unjust punishment. Pain can even be regarded as intrinsic to achievement - 'no pain, no gain'.
This unique two-day symposium brought together some of the liveliest and most widely respected creative and scholarly minds to prod, probe and discuss profound questions about the relationship between body, mind and culture. How and why do we give meaning to bodily pain?
'Pain and its Meanings' was a collaboration between the Birkbeck Pain Project and Wellcome Collection. Please see the Birkbeck Pain Project website for audio and texts related to the event.
http://www.wellcomecollection.org/whats-on/events/pain-and-its-meanings.aspx
Perspectives on Pain - 19: Interdisciplinary Studies in the Long Nineteenth, No 15 (2012)
The Birkbeck Pain Project examines narratives of bodily pain produced from the mid-eighteenth century to the present day. Funded by the Wellcome Trust, the three-year project, led by Professor Joanna Bourke, is based at the Department of History, Classics, and Archaeology.
Email: painproject@bbk.ac.uk
Web: www.bbk.ac.uk/history/our-research/birkbeckpainproject
http://www.19.bbk.ac.uk/index.php/19/issue/view/85/showToc
The Story of Pain: Joanna Bourke - Oxford University Press in press
Joanna Bourke
• The story of pain and suffering since the eighteenth century
• Addresses the big questions about the experience and nature of suffering - and how to respond to it
• Charts how our understanding of pain has changed completely over the last three centuries - from positive function to ultimate evil
• A fascinating investigation for the 21st century reader into how we have coped with suffering in the past - both our own suffering and that of the ones we love
Everyone knows what is feels like to be in pain. Scraped knees, toothaches, migraines, giving birth, cancer, heart attacks, and heartaches: pain permeates our entire lives. We also witness other people - loved ones - suffering, and we 'feel with' them.
It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'.
Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment?
As Joanna Bourke shows in this fascinating investigation, people have come up with many different answers to these questions over time. And a history of pain can tell us a great deal about how we might respond to our own suffering in the present - and, just as importantly, to the suffering of those around us.
http://ukcatalogue.oup.com/product/9780199689422.do#.UkAfpxZv1WI
It is easy to assume this is the end of the story: 'pain-is-pain-is-pain', and that is all there is to say. But it is not. In fact, the way in which people respond to what they describe as 'painful' has changed considerably over time. In the eighteenth and nineteenth centuries, for example, people believed that pain served a specific (and positive) function - it was a message from God or Nature; it would perfect the spirit. 'Suffer in this life and you wouldn't suffer in the next one'. Submission to pain was required. Nothing could be more removed from twentieth and twenty-first century understandings, where pain is regarded as an unremitting evil to be 'fought'.
Focusing on the English-speaking world, this book tells the story of pain since the eighteenth century, addressing fundamental questions about the experience and nature of suffering over the last three centuries. How have those in pain interpreted their suffering - and how have these interpretations changed over time? How have people learnt to conduct themselves when suffering? How do friends and family react? And what about medical professionals: should they immerse themselves in the suffering person or is the best response a kind of professional detachment?
As Joanna Bourke shows in this fascinating investigation, people have come up with many different answers to these questions over time. And a history of pain can tell us a great deal about how we might respond to our own suffering in the present - and, just as importantly, to the suffering of those around us.
http://ukcatalogue.oup.com/product/9780199689422.do#.UkAfpxZv1WI
Girl who feels no pain could inspire new painkillers - health - 15 September 2013 - New Scientist
A girl who does not feel physical pain has helped researchers identify a gene mutation that disrupts pain perception. The discovery may spur the development of new painkillers that will block pain signals in the same way.
People with congenital analgesia cannot feel physical pain and often injure themselves as a result – they might badly scald their skin, for example, through being unaware that they are touching something hot.
By comparing the gene sequence of a girl with the disorder against those of her parents, who do not, Ingo Kurth at Jena University Hospital in Germany and his colleagues identified a mutation in a gene called SCN11A.
This gene controls the development of channels on pain-sensing neurons. Sodium ions travel through these channels, creating electrical nerve impulses that are sent to the brain, which registers pain.
Blocked signals
Overactivity in the mutated version of SCN11A prevents the build-up of the charge that the neurons need to transmit an electrical impulse, numbing the body to pain. "The outcome is blocked transmission of pain signals," says Kurth.
To confirm their findings, the team inserted a mutated version of SCN11Ainto mice and tested their ability to perceive pain. They found that 11 per cent of the mice with the modified gene developed injuries similar to those seen in people with congenital analgesia, such as bone fractures and skin wounds. They also tested a control group of mice with the normal SCN11A gene, none of which developed such injuries.
The altered mice also took 2.5 times longer on average than the control group to react to the "tail flick" pain test, which measures how long it takes for mice to flick their tails when exposed to a hot light beam. "What became clear from our experiments is that although there are similarities between mice and men with the mutation, the degree of pain insensitivity is more prominent in humans," says Kurth.
The team has now begun the search for drugs that block the SCN11Achannel. "It would require drugs that selectively block this but not other sodium channels, which is far from simple," says Kurth.
Completely unexpected
"This is a cracking paper, and great science," says Geoffrey Woods of the University of Cambridge, whose team discovered in 2006 that mutations in another, closely related ion channel gene can cause insensitivity to pain. "It's completely unexpected and not what people had been looking for," he says.
Woods says that there are three ion channels, called SCN9A, 10A and 11A, on pain-sensing neurons. People experience no pain when either of the first two don't work, and agonising pain when they're overactive. "With this new gene, it's the opposite: when it's overactive, they feel no pain. So maybe it's some kind of gatekeeper that stops neurons from firing too often, but cancels pain signals completely when it's overactive," he says. "If you could get a drug that made SCN11A overactive, it should be a fantastic analgesic."
"It's fascinating that SCN11A appears to work the other way, and that could really advance our knowledge of the role of sodium channels in pain perception, which is a very hot topic," says Jeffrey Mogil at McGill University in Canada, who was not involved in the new study.
Neuroscientists Identify a Brain Signature of Pain: Scientific American
Like truth and beauty, pain is subjective and hard to pin down. What hurts one moment might not register the next, and our moods and thoughts color the experience of pain. According to a report in April in the New England Journal of Medicine, however, researchers may one day be able to measure the experience of pain by scanning the brain—a much needed improvement over the subjective ratings of between one and 10 that patients are currently asked to give.
Led by neuroscientist Tor Wager of the University of Colorado at Boulder, researchers used functional MRI on healthy participants who were given heated touches to their arm, some pleasantly warm, others painfully hot. During the painful touches, a scattered group of brain regions consistently turned on. Although these regions have been previously associated with pain, the new study detected a striking and consistent jump in their activity when people reported pain, with much greater accuracy than previous studies had attained. This neural signature appeared in 93 percent of subjects reporting to feel painful heat, ramping up as pain intensity increased and receding after participants took a painkiller.
The researchers determined that the brain activity specifically marked physical pain rather than a generally unpleasant experience, because it did not emerge in people shown a picture of a lover who had recently dumped them. Although physical pain and emotional pain involve some of the same regions, the study showed that fine-grained differences in activation separate the two conditions.
A brain-based marker of pain might someday help doctors assist people who have difficulties communicating, such as the very young or victims of stroke. Yet Wager does not see this neural signature as a pain "lie detector." "There are many psychological and physiological ingredients that go into a person's report of pain, and we've discovered just one ingredient here," he says. Many states of brain activity very likely give rise to pain, Wager adds, "pain is not just one thing."
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