Women’s pain: Common, treatable and often overlooked or mismanaged — ScienceDaily.
Excerpts from the 19 January article
“I can’t tell you the number of women I see who have been told they just have to live with the pain,” Dr. Thomas said. “It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women, are less likely to speak up and seek treatment for their pain.”
Credit: Image courtesy of American Society of Anesthesiologists (ASA)
Despite the variety of effective treatments, and physicians who specialize in treating pain, women often suffer unnecessarily from conditions ranging from backaches to pain after cancer surgery, and also treat their pain with medications that may be ineffective and possibly harmful, according to a review of research related to women and pain by the American Society of Anesthesiologists® (ASA®).
ASA conducted the literature review and issued the Women’s Pain Update to help raise awareness of the many options available to women for controlling both acute and chronic pain, and how a pain medicine specialist can help them choose the right treatment. Among other things, the studies showed that remedies such as music, yoga and rose oil are proven effective for several types of pain, that opioids are often used inappropriately, and that the type of anesthesia used during breast cancer surgery can affect how quickly and comfortably a woman recovers from the operation.
Physician anesthesiologists are doctors who focus on anesthesia and critical care medicine and are among the medical specialists who are experts in the subspecialty of pain medicine, seeing patients in private practices and pain clinics.
Donna-Ann Thomas, M.D., a member of ASA’s Committee on Pain Medicine, frequently sees women who have been suffering in silence for years, with conditions such as a type of back pain that can develop after childbirth, and chronic pain after breast cancer surgery.
“I can’t tell you the number of women I see who have been told they just have to live with the pain,” Dr. Thomas said of women who come to her with sciatica, a type of back pain that radiates down the leg. “It’s just heart breaking because many of these women have been suffering a long time. Women, especially older women, are less likely to speak up and seek treatment for their pain.”
Study shows integrative medicine relieves pain and anxiety for cancer inpatients.
From the 6 November 2014 EurekAlert!
Study shows integrative medicine relieves pain and anxiety for cancer inpatients
Pain is a common symptom of cancer and side effect of cancer treatment, and treating cancer-related pain is often a challenge for health care providers.
The Penny George Institute for Health and Healing researchers found that integrative medicine therapies can substantially decrease pain and anxiety for hospitalized cancer patients. Their findings are published in the current issue of the Journal of the National Cancer Institute Monographs.
“Following Integrative medicine interventions, such as medical massage, acupuncture, guided imagery or relaxation response intervention, cancer patients experienced a reduction in pain by an average of 47 percent and anxiety by 56 percent,” said Jill Johnson, Ph.D., M.P.H., lead author and Senior Scientific Advisor at the Penny George Institute.
“The size of these reductions is clinically important, because theoretically, these therapies can be as effective as medications, which is the next step of our research,” said Jeffery Dusek, Ph.D., senior author and Research Director for the Penny George Institute.
The Penny George Institute receives funding from the National Center of Alternative and Complementary Medicine of the National Institutes of Health to study the impact of integrative therapies on pain over many hours as well as over the course of a patient’s entire hospital stay.
“The overall goal of this research is to determine how integrative services can be used with or instead of narcotic medications to control pain,” Johnson said.
Researchers looked at electronic medical records from admissions at Abbott Northwestern Hospital between July 1, 2009 and December 31, 2012. From more than ten thousand admissions, researchers identified 1,833 in which cancer patients received integrative medicine services.
Patients were asked to report their pain and anxiety before and just after the integrative medicine intervention, which averaged 30 minutes in duration.
Patients being treated for lung, bronchus, and trachea cancers showed the largest percentage decrease in pain (51 percent). Patients with prostate cancer reported the largest percentage decrease in anxiety (64 percent).
From the National Center for Complementary and Alternative Medicine
Pain is the most common reason for seeking medical care. It is also a common reason why people turn to complementary health approaches.
We have collected our information on pain into an eBook you can download to your computer or mobile device.
If you have a Web-enabled device:
From the 4 April 2014 post by Karen Sibert, MD at The Health Care Blog
The problem of pain, from the viewpoint of British novelist and theologian C. S. Lewis, is how to reconcile the reality of suffering with belief in a just and benevolent God.
The American physician’s problem with pain is less cosmic and more concrete. For physicians today in nearly every specialty, the problem of pain is how to treat it responsibly, stay on the good side of the Drug Enforcement Administration (DEA), and still score high marks in patient satisfaction surveys.
If a physician recommends conservative treatment measures for pain–such as ibuprofen and physical therapy–the patient may be unhappy with the treatment plan. If the physician prescribes controlled drugs too readily, he or she may come under fire for irresponsible prescription practices that addict patients to powerful pain medications such as Vicodin and OxyContin.
From the 26 July 2013 KevinMD entry
DAVID LEE SCHER, MD | TECH | JULY 24, 2013
Music as a healing mechanism has been accepted for over 50 years. Music is a source of primal memory similar to that of smell. It has been used in brain injury patient management, as well as to promote wellness, manage stress alleviate pain, promote physical rehabilitation, and enhance memory in Alzheimer’s Disease patients.I have appreciated the power of music my whole life and as a physician and musician, realized its healing potential early on in my medical career. I burned CDs of the music chosen by my patients to be played during their surgery (usually performed with light sedation) and gave it to them as a surprise at their office follow-up visit.
I will lightly touch on some reasons why music would be a great digital health technology.
1. There are scientific studies to provide evidence of efficacy. There are very few digital health technologies that are mobile technologies which have been proven to be efficacious. Since music has been digital for decades, it is a natural for adoption as a mobile health tech tool. Here’s a nice bibliography on the uses of music therapy. Areas such as mental health, special education and Autism, and pain management have been subjects of studies.
Uncovering a healthier remedy for chronic pain.
From the Science Daily report (July 17, 2013)
Physicians and patients who are wary of addiction to pain medication and opioids may soon have a healthier and more natural alternative.A Duke University study revealed that a derivative of DHA (docosahexaenoic acid), a main ingredient of over-the-counter fish oil supplements, can sooth and prevent neuropathic pain caused by injuries to the sensory system. The results appear online in the Annals of Neurology….…
Their findings revealed that NPD1=PD1 not only alleviated the pain, but also reduced nerve swelling following the injuries. Its analgesic effect stems from the compound’s ability to inhibit the production of cytokines and chemokines, which are small signaling molecules that attract inflammatory macrophages to the nerve cells. By preventing cytokine and chemokine production, the compound protected nerve cells from further damage. NPD1=PD1 also reduced neuron firing so the injured animals felt less pain.Ji believes that the new discovery has clinical potential. “Chronic pain resulting from major medical procedures such as amputation, chest and breast surgery is a serious problem,” he said. Current treatment options for neuropathic pain include gabapentin and various opioids, which may lead to addiction and destruction of the sensory nerves.
English: Tetrahydrocannabinol; THC; Marinol-aka mary jane. (Photo credit: Wikipedia)
From the 24 December 2012 article at Medical News Today
Using cannabis for pain relief does help, however, it makes pain more bearable rather than getting rid of it, researchers from Oxford University’s Centre for Functional Magnetic Resonance Imaging of the Brain (FMRIB) reported in the journal Pain.
The authors added that people in pain act differently to cannabis, according to their brain imaging study.
The principal psychoactive constituent of cannabis is called tetrahydrocannabinol (THC). The researchers found that when volunteers took oral tablets of THC, they tended to find the experience of pain more tolerable. There was no evidence that THC reduced pain intensity.
Several studies have found that cannabis is associated with some kind of improvement in pain symptoms. Researchers from McGill University Health Centre (MUHC) and McGill University reported in CMAJ in 2010 that patients with chronic neuropathic pain experienced pain relief, improved mood and better quality sleep after smoking cannabis.
Scientists from Imperial College London found that Cannador, another cannabis plant extract, effectively relives pain after major surgery. They reported their findings in the journalAnerthesiology.
Read the entire article here
This image, from a Brigham and Women’s Hospital study, shows the Default Mode Network in patients with chronic low back pain (cLBP) and in healthy subjects (CONTROLS) before and after maneuvers which are painful for the cLBP but not for the CONTROLS. Notice that after the maneuvers, the cluster in the front of the brain is disrupted (it shows less color) in the cLBP patients, but not in the CONTROLS. This supports the study finding that pain changes brain connectivity. (Credit: Brigham and Women’s Hospital)
A possible new way to objectively measure pain
From the 20 December 2012 article at Science News Daily
Dec. 20, 2012 — More than 100 million Americans suffer from chronic pain. But treating and studying chronic pain is complex and presents many challenges. Scientists have long searched for a method to objectively measure pain and a new study from Brigham and Women’s Hospital advances that effort. The study appears in the January 2013 print edition of the journal Pain.
“While we need to be cautious in the interpretation of our results, this has the potential to be an exciting discovery for anyone who suffers from chronic pain,” said Marco Loggia, PhD, the lead author of the study and a researcher in the Pain Management Center at BWH and the Department of Radiology at Massachusetts General Hospital. “We showed that specific brain patterns appear to track the severity of pain reported by patients, and can predict who is more likely to experience a worsening of chronic back pain while performing maneuvers designed to induce pain. If further research shows this metric is reliable, this is a step toward developing an objective scale for measuring pain in humans.”
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By Kristina Fiore, Staff Writer, MedPage Today,Published: October 24, 2012
A push to treat chronic pain and financial disincentives for treating addiction may pressure clinicians into prescribing opioids for patients who are already addicted, a researcher suggested.
Over the past decade, there’s been a perfect storm of changing clinician attitudes toward pain treatment and patient attitudes towards suffering, combined with a lack of compensation for time-consuming clinic visits such as addiction counseling, Anna Lembke, MD, of Stanford University, wrote in a perspective in the New England Journal of Medicine.
That may be leading doctors to write scripts for pain pills even if they know those patients are abusing their medications, Lembke wrote.
“Treatment of pain is held up as the holy grail of compassionate medical care,” she wrote, and clinicians have, over the last decade, felt more compelled to deliver treatment.
They also have the additional pressure of consumer ratings sites, because patients who are dissatisfied may turn around and leave a less-than-favorable review online. Lembke cites the example of one colleague who will occasionally bite the bullet: “Sometimes I just have to do the right thing and refuse to prescribe them, even if I know they’re going to go on Yelp and give me a bad rating,” the colleague told her…
From the July 2012 issue of NCCAM Clinical Digest (US National Center for Complementary and Alternative Medicine)
Millions of Americans suffer from pain that is chronic, severe, and not easily managed. Pain from arthritis, back problems, other musculoskeletal conditions, and headache costs U.S. businesses more than $61 billion a year in lost worker productivity.
Pain is the most common health problem for which adults use complementary health practices. Many people with conditions causing chronic pain turn to these practices to supplement other conventional medical treatment, or when their pain is resistant or in an effort to advert side effects of medications. Despite the widespread use of complementary health practices for chronic pain, scientific evidence on efficacy and mechanisms—whether the therapies help the conditions for which they are used and, if so, how—is, for the most part, limited. However, the evidence base is growing, especially for several complementary health practices most commonly used by people to lessen pain.
This issue highlights the research status for several therapies used for common kinds of pain, includingarthritis, fibromyalgia, headache, low-back pain, and neck pain.
Information for Your Patients
Pain relief outside the pill bottle – Harvard Health Publications
Excerpts from the 18 June 2012 article
When you feel pain, do you automatically reach for a pill? Maybe it’s time to rethink that reaction. The idea that pain relief resides only in a bottle of pills is a common misconception, Harvard Medical School experts say. While medication often plays an important role in quelling pain, there’s a large arsenal of drug-free pain-relief therapies and techniques.
The Institute of Medicine estimates that 116 million adults experience chronic pain each year. It has called for “a cultural transformation in how the nation understands and approaches pain management and prevention.” Improved pain management should include a combination of therapies and coping techniques, the institute said. And a recent New York Times investigation revealed that the use of strong pain killers used too early and for too long can delay a person’s return to work and drive up the cost of treatment….
In studying pain and how to modify it, researchers and doctors often think in terms of the “gate control” theory, said Diana Post, M.D., assistant professor of medicine at Harvard Medical School. This concept holds that pain impulses can be dampened in a part of the spinal cord, called the dorsal horn, before they reach the brain. When an injury or other painful stimulus activates tiny nerve fibers, it opens the “gate” so a pain signal is sent to the brain. But if other sensory signals are coming in from other parts of the body at the same time, neurons in the spinal cord effectively disconnect the pain message and close the “gate.” Here’s a practical example: Pediatricians often try to reduce the pain of inoculations for children by rubbing the child’s skin immediately after giving the shot to offset, or garble, the original pain signal.
Other pain-relief therapies abound, Post said. These include:
- mind-body relaxation techniques
- physical therapy
- and occupational therapy….
Treating neck pain with a dose of exercise – Harvard Health Publications
Excerpt from the article
POSTED DECEMBER 12, 2011, 9:59 AM
Do your neck and shoulders ache? Not long ago, you would have been told to rest, maybe use a neck brace, and wait until the pain had ebbed away. Doctors have changed their song about the best treatment for neck and shoulder pain. They now recommend movement instead of rest.
As described in Neck and Shoulder Pain, a newly updated Special Health Report from Harvard Health Publications, there is mounting scientific evidence for the role of stretching and muscle strengthening in treating people with neck and shoulder pain. After a whiplash injury, for example, people heal sooner and are less likely to develop chronic pain if they start gentle exercise as soon as possible. For those with long-term pain (called chronic pain), results from controlled studies show that exercise provides some relief…..
From the 9 December 2011 Medical News Today article
Children who suffer from persistent or recurring chronic pain may miss school, withdraw from social activities, and are at risk of developing internalizing symptoms such as anxiety, in response to their pain. In the first comprehensive review of chronic pain in children and adolescents in 20 years, a group of researchers found that more children now are suffering from chronic pain and that girls suffer more frequently from chronic pain than boys.
Their findings indicate that most types of pain are more prevalent in girls than in boys, but the factors that influence this gender difference are not entirely clear. Pain prevalence rates tend to increase with age. Psychosocial variables impacting pain prevalence included anxiety, depression, low self-esteem, and low socioeconomic status. Headache was found to be the most common studied pain type in youth, with an estimated prevalence rate of 23%. Other types of pain, ie, abdominal pain, back pain, musculoskeletal pain, and pain combinations, were less frequently studied than headache, and prevalence rates were variable because of differences in reporting. However, the overall results indicated that these pain types are highly prevalent in children and adolescents, with median prevalence rates ranging from 11% to 38%. “These rates are of great concern, but what is even more concerning is that research suggests that the prevalence rates of childhood pain have increased over the last several decades,” stated Dr. King.
Researchers also found that many studies did not meet quality criteria and there was great variability in prevalence rates across studies due to time periods over which pain was reported……
Hippocrates stares down at the UCSF doctors, continually reminding them to stick to his oath.
From the 14 Novemer 2011 Eureka news alert
Research includes drug and non-drug interventions
Washington — Scientists are discovering promising approaches to treating pain, one of the most common and debilitating neurological complaints, according to research released today at Neuroscience 2011, the annual meeting of the Society for Neuroscience and the world’s largest source of emerging news about brain science and health. Studies show that “mirror box therapy” can help reduce arthritis-related pain, and that a new opioid-like drug may be able to relieve acute pain without the euphoric effects that can lead to dependency. Additional research also identifies the possible neurobiological source of common side effects of morphine.
Specifically, today’s new findings show that:
- Two of morphine’s most common side effects, itch and headache, may be due to the drug’s activation of immune cells in the membrane surrounding the brain and spinal cord (Julie Wieseler, PhD, abstract 178.12, see summary attached).
- A visual feedback technique called mirror box therapy can help alleviate hand pain in patients with arthritis (Laura Case, abstract 72.03, see summary attached).
- In an animal study, a novel drug relieves acute pain without the dangerous side effects associated with opioid painkillers such as morphine (Stephen Harrison, PhD, abstract 178.10, see summary attached).
Other recent findings discussed show:
- A gene therapy treatment reduced pain in 10 people in a Phase I clinical trial that tested for treatment safety (David Fink, MD, see attached speaker’s summary).
- A naturally occurring protein that supports the survival and growth of neurons in the brain and spinal cord may be a potential therapeutic intervention to prevent chronic pain following spinal cord injuries, according to animal research (Ching-Yi Lin, PhD, see attached speaker’s summary).
“Pain is one of the most intransigent and difficult symptoms to treat,” said Allan I. Basbaum, PhD, FRS, of the University of California, San Francisco, press conference moderator and expert on the neurobiology of pain. “These studies and others are helping us better understand the complex neural pathways involved in pain and the long-term consequences of injury. With this, researchers will be better poised to develop approaches to alleviate pain and aid in recovery from injuries.”
This research was supported by national funding agencies, such as the National Institutes of Health, as well as private and philanthropic organizations. Dr. Basbaum has consulted with Nektar Therapeutics, Inc., but was not involved in research presented today.
View full release at www.sfn.org/newsroom.
The American Pain Foundation will soon be launching a PainSafe (Safety & Access For Everyone) module on CAM and pain. This module, created with materials and assistance from NCCAM, aims to educate and empower both consumers and health care professionals.
From the 15 August Eureka news item
Pain care management needs to be improved, with health care professionals committing to improve care as well as a retooling of the health care system to help people who are suffering, states an editorial in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/site/embargo/cmaj111065.pdf.
According to a recent analysis, chronic pain affects people of all ages, with an estimated 500,000 Canadians aged 12 to 44 years, 38% of seniors in long-term care institutions and 27% of seniors living at home experiencing regular pain.
“Experts agree that much can be done now with newer analgesics, nonpharmacologic techniques such as nerve blocks and physical therapies, as well as spiritual and supportive care,” write Drs. Noni MacDonald, Ken Flegel, Paul Hébert and Matthew Stanbrook. “Availability of quality care for pain is the major problem. Health professionals have not mounted a response commensurate with the magnitude of the problem.”
The authors argue for a broad strategy to help increase pain management expertise, including education, technology, and supported self-care and lay coaching.