HOOEOPATHIC REMEDIES FOR LIPOMA

A lipoma is a slow-growing, fatty lump that's most often situated between your skin and the underlying muscle layer. A lipoma, which feels doughy and usually isn't tender, moves readily with slight finger pressure. Lipomas are usually detected in middle age. Some people have more than one lipoma. A lipoma isn't cancer and usually is harmless

The cause of lipomas is unknown. Lipomas tend to run in families, so genetic factors likely play a role in their development.

Symptoms--Lipomas can occur anywhere in the body. Lipomas are:

·         Situated just under your skin. They commonly occur in the neck, shoulders, back, abdomen, arms and thighs.

·         Soft and doughy to the touch. They also move easily with slight finger pressure.

·         Generally small. Lipomas are typically less than 2 inches (5 centimeters) in diameter, but they can grow.

·         Sometimes painful. Lipomas can be painful if they grow and press on nearby nerves or if they contain many blood vessels.

Less frequently, some lipomas can be deeper and larger than typical lipomas.

TOP HOMOEOPATHIC REMEDIES

CALCAREA CARB. 200—CM-- Calcarea Carb is the one of the top constitutional Homeopathic medicines Lipoma. Generally the person requiring Calcarea Carb is obese. Various constitutional characters need to be verified before its use. The first among these is the tendency to sweat excessively on the head. The second is sensitivity to cold air. Last come the special demands in eating habits like a craving for boiled eggs and indigestible things like lime and chalk. Long-standing constipation and acidity may be found associated with Lipoma in a few cases. If these constitutional symptoms match the patient’s symptoms, Homeopathic medicine Calcarea Carb can help in complete disappearance of Lipomas.

 SUPHUR 200-CM-- Sulphur is the next constitutional Homeopathic medicine that can prove extremely helpful in treating Lipomas. Sulphur is an equally powerful medicine like Calcarea Carb to treat Lipoma. But which medicine will suit which patient depends upon his or her constitution. Just like Calcarea Carb, Sulphur has unique constitutional symptoms for its use. An important constitutional feature for choosing Sulphur is extreme hot sensations in the body. The heat may be more marked in the palms, soles and head. The skin remains mostly dry and looks dirty. Some sort of skin trouble at present or in the past may be looked at while taking up the patient’s case. Another characteristic feature is a marked aversion to bathing. And In dietary habits, the patient may have a high demand for sweets.

AMMONIUM MUR 30-Ammonium mur. is very effective for lipoma in obese persons. Here the body is fat but the legs are thin.

BARYTA CARB 30-Baryta carb. is another excellent remedy for lipoma, especially lipoma is seen on the neck.There is swelling and induration of the glands.

BELLADONNA 200--Homeopathic medicine Belladonna is beneficial when the Lipoma is painful. The pain may worsen on touching the lump. Here, Belladonna will help in providing relief from pain and also dissolving the Lipoma.

LAPIS ALBUS 30-Lapis albus is considered a an almost specific remedy for lipoma. It has certain pliability and elasticity. Enlargement and induration of glands especially cervical glands.

CROCUS SATIVA 30- Crocus sativa is another remedy for lipoma , especially on the scalp. It is fatty in nature and there is a feeling of prickling and crawling sensation in the skin.

CALCAREA FLOUR. 30—Calcarea flour is an effective remedy for lipoma , especially lipomas are hard and stony.

THUJA OCC. 200- CM --Thuja is a Homeopathic medicine that is of great help in treating abnormal growth originating anywhere in the body. Thuja possesses a powerful ability to help in complete dissipation of fatty accumulations. If a person with Lipomas has high blood cholesterol levels, the use of Homeopathic medicine Thuja is again very beneficial.

Anticonvulsants Anti epileptics For Neuropathy

Today's post from painhq.org (see link below) looks at the main anticonvulsants or anti-epileptic drugs that are prescribed for neuropathic pain. Many people are prescribed anti-convulsants after other pain killers and anti-depressive drugs have failed and many wonder why. The implications of being prescribed drugs that are essentially meant for a totally different condition, can be alarming, so this sort of article is useful in explaining which drugs are involved and what they do. If you are prescribed an anti-convulsant, it's also worthwhile discussing any possible side effects with your doctor, so that you're fully aware of any future complications.

What are Anticonvulsants?

Anticonvulsants are a group of drugs that were designed to help manage seizures, but have since been used in the treatment and management of neuropathic pain. It is a fairly large and diverse family of drugs, sometimes referred to as ‘anti-seizure medications’ or ‘antiepileptics’. These drugs are thought to work through a number of different mechanisms: some may block different neurotransmitters; others may affect nerve signalling and ‘firing’ through binding to different receptors; altering ion channels in the brain; or ‘stabilizing’ some of the nerve cell membranes to ‘quiet’ pain signalling. On balance, it is thought that through these various mechanisms anticonvulsants affect pain communication pathways for patients with neuropathic pain.

How do they work?

Anticonvulsants were first used in pain management because it was thought that the nature of pain was somewhat similar to that of epileptic seizures – too much nerve cell firing. A number of these drugs have been shown to block the signals from damaged neurons which would normally communicate pain within the body.

What kinds are there?

Gabapentin (Neurontin): Gabapentin works by binding to the calcium channels in neurons. These calcium channels help communicate pain within the body and, when blocked, help to dull the signal. Gabapentin is one of the only drugs used to treat neuropathic pain that is solely metabolized through the kidney (most are metabolized through the liver). It is considered one of the ‘first line’ medication treatments for most neuropathic pain syndromes. It is often used for treating post-herpetic neuralgia and diabetic neuropathy. 

Pregabalin (Lyrica): Developed as a more potent follow-up to Gabapentin, Pregabalin has been prescribed for postherpetic neuralgia, diabetic peripheral neuropathy and central neuropathic pain. Pregabalin is also associated with a lower risk for dependency and potential abuse.

Carbamazepine (Tegretol) / Oxcarbazepine (Trileptal): Carbamazepine works by binding to sodium channels in neurons and limiting pain signals. Used It is frequently used to treat trigeminal neuralgia, but also diabetic neuropathy and potentially other forms of neuropathic pain (though more research is necessary). 

Valproate (Sodium valproate, valproic acid): Valproate helps block calcium channels and increases the levels of GABA in the brain. The calcium channels help to communicate pain while GABA helps to black dull pain signals in the brain by blocking communication channels and affecting nerve transmission. More evidence is needed to determine the use of Valproate in the treatment of neuropathic pain. 

Lamotrigine (Lamictal): Lamotrigine helps to block sodium channels and helps to regulate signals between neurons. Used it is sometimes used in the treatment of trigeminal neuralgia, diabetic neuropathy and central neuropathic pain. There are increased risks of side effects in woman using Lamotrigine, which also poses certain risks for pregnancies.

Topiramate (Topamax): Topiramate has a number of mechanisms of action including sodium channels, calcium channels, GABA receptors, AMPA receptors and carbonic anhydrases. More evidence is needed to determine the use of Topiramate in the treatment of neuropathic pain.

Levetiracetam (Keppra): Levetiracetam works by binding to calcium channels in neurons, though it’s mechanisms aren’t fully understood. It can be used in the treatment of peripheral neuropathic pain. 

Lacosamide (Vimpat): Lacosamide works by binding to sodium channels in neurons, which prevents them from firing. Lacosamide also targets the cell which have been active for a longer period of time; in other words, damaged, over-active nerve cells that are sending pain signals (versus healthy cells). Lacosamide is used in the treatment of diabetic peripheral neuropathy.

Related evidence

Hearn L, Derry S, Moore RA. Lacosamide for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2012 Feb 15;2:CD009318. doi: 10.1002/14651858.CD009318.pub2.

Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD007076. DOI: 10.1002/14651858.CD007076.pub2

Moore R, Wiffen PJ, Derry S, Toelle T, Rice AS C. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD007938. DOI: 10.1002/14651858.CD007938.pub3

Price MJ. Levetiracetam in the treatment of neuropathic pain: three case studies. Clin J Pain. 2004 Jan-Feb;20(1):33-6.

Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, Lunn MP, Hamunen K, Haanpaa M, Kalso EA. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013 Nov 11;11:CD010567. doi: 10.1002/14651858.CD010567.pub2.

Wiffen PJ, Derry S, Lunn MPT, Moore R. Topiramate for neuropathic pain and fibromyalgia in adults. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD008314. DOI: 10.1002/14651858.CD008314.pub3

 http://www.painhq.org/learning/knowledge-base/category/treatments/traditional-medicine-and-surgery/anticonvulsants

Treatment Diagnosis of hernia

Diagnosis

For those who have an obvious hernia, the doctor might not require any other tests (if you're healthy otherwise). For those who have symptoms of a hernia (dull ache in groin or any other body area with lifting or straining but with no obvious lump), a doctor may feel the area while increasing abdominal pressure (having you stand or cough). This course of action may make the hernia capable of being felt. If you have an inguinal hernia, a doctor will feel for the possibility pathway and look for a hernia by inverting your skin of the scrotum together with his or her finger.

Treatment

Self-Care in your own home

In general, all hernias ought to be repaired unless severe preexisting health conditions make surgery unsafe. The potential exception to this is really a hernia with a large opening. Trusses and surgical belts or bindings might be helpful in holding back the protrusion of selected hernias when surgical treatment is not possible or should be delayed. However, they ought to never be used in the situation of femoral hernias.
Avoid activities that increase intra-abdominal pressure (lifting, coughing, or straining) that could cause the hernia to increase in dimensions

Medical Treatment

Treatment of a hernia depends upon whether it is reducible or irreducible and perhaps strangulated.
Reducible hernia
In general, all hernias ought to be repaired to avoid the potential of future intestinal strangulation.
For those who have preexisting medical conditions that will make surgery unsafe, your physician may not repair your hernia and can watch it closely.
Rarely, your physician may advise against surgery due to the special condition of the hernia.
Some hernias have or develop large openings in the abdominal wall, and shutting the opening is complicated due to their large size.
Most of these hernias may be treated without surgery, perhaps using abdominal binders.
Some doctors believe the hernias with large openings possess a low risk of strangulation.
Treating every hernia is individualized, along with a discussion of the risks and advantages of surgical versus nonsurgical management must take place between the doctor and patient.

Irreducible hernia

All acutely irreducible hernias need emergency treatment due to the risk of strangulation.
An attempt to lessen (push back) the hernia will normally be made, often after giving medicine for pain and muscle relaxation.
If unsuccessful, emergency surgical treatment is needed.
If successful, however, treatment depends upon the length of the time the hernia was irreducible.
If the intestinal items in the hernia had the circulation cut off, the development of dead (gangrenous) bowel can be done in as little as six hours.
In the event in which the hernia has been strangulated to have an extended time, surgical treatment is performed to check if the intestinal tissue has died and also to repair the hernia.
In the event in which the length of time the hernia was irreducible was short and gangrenous bowel isn't suspected, you may be discharged in the hospital.
Because a hernia which was irreducible and is reduced includes a dramatically increased chance of doing so again, you need to therefore have surgical correction at some point.

Occasionally, the long-term irreducible hernia isn't a surgical emergency. These hernias, having passed the exam of time without signs and symptoms of strangulation, may be repaired electively.

Brain Implants To Control Pain The Way Forward

Today's post from painresearchforum.org (see link below) is one of those that gives hope for the future but makes us wish that the future was a little bit closer by. It talks about transcranial magnetic stimulation, which means that drugs can be avoided by means of an implant in the brain which alters circuit activity in the brain itself. This means that pain signals can be interrupted, or controlled. It's a complex, scientific article but simply enough explained to give you a good idea of what is meant. The article does warn that this procedure is not without its doubters and maybe risks and needs to be refined so that its results prove beyond doubt that it's an effective treatment. However, such warnings are reassuring to the reader that it's being taken seriously and it's clearly a promising development for future pain control without having to resort to drugs and medications. Another case of 'watch this space'.


Transcranial Magnetic Stimulation: The Next Wave in Pain Treatment?
Non-invasive technique shows promise but needs more study
by Stephani Sutherland on 3 Oct 2013 
 
Electrical stimulation of the motor cortex was established as an effective treatment for pain 20 years ago, but the risks and drawbacks of surgically implanting electrodes in the brain keep many patients from pursuing this invasive treatment (Tsubokawa et al., 1991; Kurata, 1993; Nguyen et al., 2011). What if there was a safer, non-invasive way to deliver analgesic neurostimulation? Transcranial magnetic stimulation (TMS) holds out promise as just such a next-generation pain treatment. In TMS, a magnetic field generated outside the head alters circuit activity inside the brain. TMS was approved in 2008 by the U.S. Food and Drug Administration for treatment of major depression, and researchers are investigating TMS for a number of other neurological conditions, including chronic, intractable pain.

Anne Louise Oaklander, a neurologist and pain researcher at Massachusetts General Hospital, Boston, US, said there is much work to be done, but the potential payoff of TMS for pain makes it well worth pursuing. “It has a huge potential advantage over pain medications,” she said. Drugs move indiscriminately throughout the body, often causing side effects at non-target tissues that limit their use or even prevent them from getting into the clinic. TMS, by contrast, delivers its therapeutic effects directly to the brain, with only minor, local side effects. “That is the trump card of TMS over drugs,” Oaklander said.

The evidence

Because TMS can modulate brain circuits safely and painlessly, the technique has had tremendous utility for studying pain processing, said Jean-Pascal Lefaucheur, a pioneer in the field of neurostimulation for pain at the Université Paris-Est, Créteil, France. Lefaucheur and his colleagues recently reviewed some of the hundreds of small studies that have examined the effects of TMS on evoked pain in experimental settings (Mylius et al., 2012). (In a separate review, Lefaucheur and colleagues recently discussed the mechanisms of action and the clinical indications of TMS for non-invasive stimulation therapy of pain disorders; see Nizard et al., 2012.)

Clinically, TMS is routinely used as a screening technique to predict a patient’s reaction to cortical stimulation before surgical implantation of electrodes, said Lefaucheur. A person who responds to TMS will almost always benefit from brain stimulation with implanted electrodes, he said. If a patient could receive the same benefit without implantation surgery, all the better.

But few studies have addressed the technique’s clinical efficacy. A 2010 Cochrane Review of non-invasive brain stimulation aimed at chronic pain looked at the accumulated data and concluded that high-frequency TMS showed a small but consistent reduction in patient-reported pain scores compared to sham treatment (O’Connell et al., 2010). Most of the studies’ participants had chronic, intractable neuropathic pain, and TMS produced a small and transient decrease in pain scores by about 15 percent for up to a week. However, inadequate sham controls and blinding may have exaggerated this effect, said lead author Neil O’Connell, Brunel University, Uxbridge, UK.

Although the pooled data involving just 368 subjects in 19 trials did not provide Neil O’Connell evidence of a clinically meaningful, long-term analgesic effect of TMS, O’Connell said one could yet emerge with further study. It is difficult to synthesize the results of small, heterogeneous studies, he told PRF. While it would be premature to roll out TMS clinically for pain, “I absolutely encourage scientists to study it more,” O’Connell said. “I am not saying it will not be useful [in the clinic], just that substantial uncertainty remains.” An updated review now in preparation will include more studies, but the conclusions for TMS will not change drastically, O’Connell said.

The rationale

All brain stimulation techniques work by activating neural circuitry. With TMS, a figure eight-shaped plastic paddle containing a coiled wire is placed over the head and briefly charged with high-intensity current, inducing a magnetic field that passes into the brain. Just as a wire placed in a magnetic field will carry current, so do axons. Neurostimulation therapy, Lefaucheur explained, prompts axons to fire action potentials and thereby influences circuits. “It is not [just] a local stimulation. You can stimulate local, short circuits or circuits with distant projections,” he said. Accordingly, TMS of the richly connected cortex can modulate the activity of structures deep within the brain.

Perhaps because its effects go beyond the cortex, David Yeomans TMS seems to affect different aspects of the experience of pain. “Pain is not a monolithic entity,” said David Yeomans, a pain researcher at Stanford University, California, US. Just as pain can arise from a variety of sources, so does it vary in its qualities and characteristics—for example, our discriminative sense feels the bodily sensation of pain, but the emotional aspects of pain cause our suffering.

Cortical stimulation seems to affect both these components, said Lefaucheur. Improvement of the sensory discrimination of pain might arise from modulation of descending inhibition circuits, which pass through the thalamus en route to brainstem structures and the spinal cord. In contrast, changes in the emotional aspects of pain likely arise from effects on the brain’s limbic circuitry, he explained.

Like any treatment, people do not respond uniformly to TMS; patients may see improvement in one aspect of the pain experience but not the other.

In practice

Further complicating the clinical understanding of TMS are the endless variations in its delivery. In clinical studies, the motor cortex has emerged as the clear winner in terms of where to target TMS for pain; the few studies that were aimed at dorsolateral prefrontal cortex—the bullseye for treating depression—were ineffective for pain (O’Connell et al., 2010). But the clarity ends there when it comes to the details of effective stimulation. Where, for example, within the motor cortex should one stimulate? One might aim intuitively at the cortical real estate representative of the painful area, but experts agree that the analgesic effects do not correspond to the somatotopic map.

Repetitive TMS (rTMS), in which a series of pulses is delivered in rapid succession within a single session, has emerged as the preferred method, but the protocol can be highly variable in details such as pulse frequency, stimulation intensity, and timing and duration of the treatments—for how long and how often should rTMS be delivered? The exact best technique is likely to vary for different people with different types of pain. Most clinical studies have used a pulse frequency somewhere between 1 and 10 hertz, with high-frequency stimulation consistently producing better effects than low-frequency (O’Connell et al., 2010).

It now seems clear that any long-lasting effects on pain will require multiple sessions of rTMS. In addition to the clinical evidence for the treatment’s transient nature, one current theory of how rTMS works also fits with the need for ongoing sessions. Multiple sessions of rTMS might affect the brain’s connectivity much like learning does. When you learn to play the piano or speak a new language, Oaklander said, “you create new synapses and you lose others; you change your brain.” If TMS engages the same types of synaptic plasticity, many treatments might be required to reshape signaling in circuits molded by chronic pain. As for how many, Oaklander said, “Nobody knows how often it needs to be repeated.” Treatments might be required daily at first and then as often as weekly for months or even years.

The updated Cochrane Review will include several studies of multiple sessions, O’Connell said, which were absent from the 2010 review. In one recent small study, a course of 14 rTMS sessions over 21 weeks for fibromyalgia resulted in long-term improvements in pain and quality-of-life scores (Mhalla et al., 2011). But even repeated treatments might not change the brain enough to provide lasting relief for some. The first randomized, multicenter, sham-controlled trial of repeated rTMS for neuropathic pain showed that 10 daily 5 Hz sessions provided only short-lived benefits with no cumulative effects (Hosomi et al., 2013).

Youichi Saitoh, a neurosurgeon at Osaka University in Japan and lead author of that study, believes that relief from neuropathic pain will require indefinite treatment with rTMS. Even in patients with implanted electrodes who have used neurostimulation for 10 years, analgesia does not last beyond about a day, Saitoh told PRF in an email. That leads him to think that rTMS does not lead to permanent neuroplastic changes in the pain processing system, he said.

Some researchers are investigating whether multiple sessions of rTMS cause structural remodeling in the brain. Neuropathic pain leads to well-documented structural changes in the brain, for example in the cingulate cortex (May, 2008). Yeomans and his colleagues plan to use brain imaging to investigate whether those changes might be reversed following a course of treatment with rTMS.

In practice, the delivery of TMS over multiple sessions remains a challenge because of the need to reproducibly target a specific brain area from outside of the head. Newly developed magnetic resonance imaging (MRI)-guided neuro-navigation can help the technician to hit the intended mark, but it remains to be seen whether the exceedingly expensive technique will be worth the price tag.

The cutting edge

One property—some would say limitation—of TMS is that it can only reach regions that lie within centimeters of the brain’s surface. Could pain pathways be better

In MRI-guided TMS, the operator holds the figure-eight coil to the patient’s scalp while monitoring the brain stimulation site on the three-dimensional MRI. Stereotactic spheres mounted on the coil identify its position relative to the spheres on the goggles that localize the patient’s head. Credit: Roi Treister, Massachusetts General Hospital, Boston, UStargeted at deeper structures? Several groups are asking that question. Brainsway, a company in Israel, has developed an “H-coil” to deliver what they call deep TMS. In a recent study, researchers used the H-coil to target the area of the motor cortex representing the leg, deep in the central sulcus, in subjects with diabetic neuropathy and saw pain relief that lasted up to three weeks (Onesti et al., 2013). In other work, Yeomans and his collaborators used four coils and what he described as “high-level math” to model how the combined coils might “shape” magnetic fields to direct currents deep into the brain (Tzabazis et al., 2013). They aimed at the dorsal anterior cingulate cortex (dACC), an area Yeomans says is activated by any experience of pain, according to neuroimaging studies. In their study, both acute pain in healthy subjects and chronic pain in subjects with fibromyalgia were attenuated by rTMS.

Although leading researchers in the field were supportive of these exploratory forays into the deeper reaches of TMS, they overwhelmingly agreed that what is most needed is a better fundamental understanding of the technique. Who might benefit most from TMS—people with neuropathic pain or other forms of pain? What is the optimal stimulation site, at what device settings, when and for how long? And what will benefits look like? How might TMS treatment interact with analgesic drugs? All of these basic questions remain unanswered. “It is a very complicated problem,” said Lefaucheur. “We need a large series of patients to clearly determine the correlations” among all these factors, he said.

O’Connell agreed and in a 2011 editorial (O’Connell and Wand, 2011) argued that rather than develop new coil configurations, researchers should prioritize robust Anne Louise Oaklander but basic studies of TMS. “Large, well-controlled studies are needed to test whether that early promise is real,” he said. Oaklander and her team recently wrote a review of TMS (Treister et al., 2013, in press in Rambam Maimonides Medical Journal) and have applied for funding for the planning stage of a large-scale clinical trial of TMS for neuropathic pain. This October, the Radcliffe Institute of Harvard University will host a gathering of scientists, clinicians, and regulatory agents to set out a path to designing such a trial. (Click here for more information; interested researchers are invited to a poster session and reception associated with the workshop.)

Other non-invasive stimulation techniques are being investigated, too, including transcranial direct current stimulation (tDCS) and cranial electrotherapy stimulation (CES), in which electrodes applied to the scalp deliver low-intensity current directly. Much fewer data are available for these modalities compared to TMS: The Cochrane review of six small studies suggested tDCS might provide a slight benefit for pain, but the updated review of data suggests no significant effect over sham stimulation, O’Connell said. CES appeared to provide no benefit in four studies reviewed.

The bottom line

Even if the promise of TMS for pain holds up, the technique surely will not be a panacea. “The main limitation for TMS is the short duration of its [analgesic] effect,” said Lefaucheur. “It may not be feasible for some refractory, chronic neuropathic pain,” he said, considering the ongoing need for treatment that is costly, time-consuming, and requires technical expertise for delivery. Lefaucheur has had several patients with neuropathic pain who initially shunned electrode implantation for rTMS, but after a year of the toil of monthly treatments, they eventually opted for surgery.

In Japan, Saitoh and his colleagues are working to make daily rTMS treatment more accessible by developing a cheap, user-friendly rTMS machine for everyday home use. He hopes such a device will eliminate the need for electrode implantation.

Overall, TMS may be more useful to treat acute forms of pain and pain that is not so refractory to other treatments, Lefaucheur concluded. In treating depression, TMS is often used for a few days during an acute depressive episode, and “there can be a synergy between stimulation and [antidepressant] drugs,” Lefaucheur said. But with refractory, chronic pain, “the pain is constant, and the drugs do not work well.” Such conditions may require ongoing treatment in repeated sessions.

Despite the caveats and the need for more study, researchers were hopeful that rTMS could turn out to be useful in the pain clinic. David Brock, Medical Director at Neuronetics, Malvern, Pennsylvania, US, a company that makes the TMS machines widely used in clinics for depression, likens TMS to a Swiss Army knife. “We have figured out how to use one blade—for depression—but it has so many other potential tools. We just have to figure out how to use them,” he said. If TMS can change the disease state of chronic pain without drugs, as it has for depression, Brock said, “that would be a real boon to patients and society.”

Stephani Sutherland, PhD, is a neuroscientist, yogi, and freelance writer in Southern California.

http://www.painresearchforum.org/news/32343-transcranial-magnetic-stimulation-next-wave-pain-treatment

Sex During Pregnancy

Ring Bandeau Bikini

AskMen's Dating channel offers you all the advice you need to become a Better Man in romance and relationships..Emergency contraception safely and effectively prevents pregnancy up to five days after unprotected..Printables, coloring pages, recipes, crafts, and more from your child's favorite Nickelodeon and Nick Jr. shows..Live a healthier life with TODAY's health tips and find the latest news for personal wellness, fitness,t and relationships..Medical news and health news headlines posted throughout the day, every day.TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Comprehensive advice, help and information aboutuality,ual health and relationships for teens and young adults..Etymology. The word "insect" comes from the Latin word insectum, meaning "with a notched or divided body", or literally "cut into", from the neuter singular perfect .Diagnosis. Microcephaly can be diagnosed during pregnancy or after the baby is born. During Pregnancy. During pregnancy, microcephaly can sometimes be .Pregnant Couples. The risk of Zika from is of greatest concern for pregnant women, who can pass Zika to their developing fetus if infected during pregnancy..

Just The Facts During Pregnancy New Parent

During Pregnancy

Pregnant Couples. The risk of Zika from . is of greatest concern for pregnant women, who can pass Zika to their developing fetus if infected during pregnancy..TODAY Parents is the premiere destination for parenting news, advice community. Find the latest parenting trends and tips for your kids and family on TODAY.com..Comprehensive advice, help and information aboutuality,ual health and relationships for teens and young adults..Live a healthier life with TODAY's health tips and find the latest news for personal wellness, fitness,t and relationships..Emergency contraception safely and effectively prevents pregnancy up to five days after unprotected .Etymology. The word "insect" comes from the Latin word insectum, meaning "with a notched or divided body", or literally "cut into", from the neuter singular perfect .New guideline on calcium and vitamin D supplementation New target identified to combat deadly allergic reactions Women who opt for laughing gas during labor, may .AskMen's Dating channel offers you all the advice you need to become a Better Man in romance and relationships..Diagnosis. Microcephaly can be diagnosed during pregnancy or after the baby is born. During Pregnancy. During pregnancy, microcephaly can sometimes be diagnosed . This page has information about general copyright restrictions that apply to the material that is available through the PubMed Central PMC site. There .

Anima Center Events

For those of you who travel and for those of you searching for just the right sacred journey to save for:

THIS IS IT

Anima Center's Sacred Canyon is the place to go.

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We invite and welcome your participation in any of the following workshops and gatherings, held in a magnificent river canyon and ancient place of power, deep in the mountains of the enchanted Southwest… 5 hrs. from the Tucson airport, or 4.5 hrs. south of Albuquerque.

Anima Wilderness Learning Center & Medicine Woman Tradition

SUMMER EVENTS(by donation)
May 22-27: The Wild Women’s GatheringA six day event for women only, with a focus on primitive camping, interaction with the natural world and personal rewilding: learning to trust our senses, instincts and needs – and to heed our callings and live our dreams regardless of constraints, norms, fears and habits.

June 12-17: The Woman Spirit GatheringAnother six day women’s event, a memory-making celebration of the spirit of womanhood, dedicated to self nourishment, sisterly sharing and sweet savoring – with inspiring teaching circles, wonderful outdoor feasts, swimming, singing and riverside dancing!

July 3-6: The Shaman’s Path IntensiveFor men as well as women, a four day long workshop imparting insights and techniques for heightening awareness, connecting with inspirited nature, exploring alternate realities, instigating ecstatic states, developing our powers to affect events, and defining and fulfilling our individual most-meaningful purpose.

Aug 1-6: The Medicine Woman GatheringSix days of presentations and discussions, plant walks and medicine making – for women who feel called to a healer’s life of intense awareness and personal responsibility. The Medicine Woman Tradition defines healing as contributing to wholeness and balance… of our selves, of others, and of the living world we are a part of.

Aug 29 -Sep 1: The Wild Foods WeekendFour days of learning to identify, gather, preserve and deliciously prepare a wide number of the wild native foods of the mountainous West and Southwest – increasing observation skills, self confidence and our ability to survive, while helping us connect deeper to the natural world and cycles of life that we are each a natural part of.

If you can forward this announcement to your email lists, it would be greatly appreciated. For more information, or for Registration forms you can download, please go to the Anima Events page at:www.animacenter.org

Anima Center also offers Retreats with meals in riverside cabins, Vision Quests, personal Counsel, resident Internships and Apprenticeships, and empowering Correspondence Courses including the Way Of Heart, Shaman and Medicine Woman paths. There is no set charge for any of the various opportunities, services, courses and events… only a suggested, sliding scale donation.
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Vitamins B12 And D3 For People Living With Neuropathy And HIV

Today's post from nybc.wordpress.com (see link below) looks at Vitamins B12 and D3; two of the key vitamins people should ensure remain at healthy levels, when living with the side effects of HIV including neuropathy. Of course, the New York Buyers Club is a very well known supplier of supplements and vitamins and this blog makes a point of not advertising for commercial sites but this article does give some very good medical information based on the findings of the Canadian, Catie HIV organisation and reliably informs you of the reason why you might need supplementation - after that the decision is yours as to where you buy what you need. Personally, I would always check with your doctor first - a simple blood test will tell you if you're deficient in any vitamin or mineral areas and it's possible you can get any supplements free on prescription after that - if not, perfectly good supplements can be bought cheaply almost everywhere these days. There are also various other articles about B and D vitamins to be found in the list to the right of this blog and they may help further with your decision making.

Why Vitamins B12 and D3 Are Especially Important to People with HIV 
Posted by jarebe December 8, 2013 New York Buyers’ Club – The Blog
A nonprofit source for dietary supplements
 
Our friends at the Canadian AIDS Treatment Information Exchange (CATIE), a Canadian government-supported education and prevention organization, recently published an excellent guide to managing HIV medication side effects. This online guide covers the territory from body shape changes, to gastrointestinal disorders, to neurological effects, to emotional wellness, to fatigue, to sexual difficulties.

The Appendix to this guide focuses on two vitamins, both of which have been highlighted as especially important for people with HIV: B12 and D3. Deficiency of these two vitamins appears to be common among people with HIV, and supplementing to correct the deficiency can bring about major improvements in health. So it’s definitely worthwhile to check your B12 and D3 status, and, if you’re deficient, find a good supplementation strategy. Note that NYBC stocks both of these inexpensive vitamins: the methylcobalamin form of Vitamin B12 recommended below; and several strengths of Vitamin D3, including the commonly recommended D3 – 2500IU format.

Below are the CATIE recommendations:

Vitamin B12

A number of studies have shown that vitamin B12 is deficient in a large percentage of people with HIV, and the deficiency can begin early in the disease. Vitamin B12 deficiency can result in neurologic symptoms — for example, numbness, tingling and loss of dexterity — and the deterioration of mental function, which causes symptoms such as foggy thinking, memory loss, confusion, disorientation, depression, irrational anger and paranoia. Deficiency can also cause anemia. (See the section on Fatigue for more discussion of anemia.) It has also been linked to lower production of the hormone melatonin, which can affect the wake-sleep cycle.

If you have developed any of the emotional or mental symptoms mentioned above, especially combined with chronic fatigue, vitamin B12 deficiency could be contributing. This is especially true if you also have other symptoms that this deficiency can cause, including neuropathy, weakness and difficulty with balance or walking. On the other hand, these symptoms can also be associated with HIV itself, with hypothyroidism or advanced cases of syphilis called neurosyphilis. A thorough workup for all potential diagnoses is key to determining the cause.

Research at Yale University has shown that the standard blood test for vitamin B12 deficiency is not always reliable. Some people who appear to have “normal” blood levels are actually deficient, and could potentially benefit from supplementation.

The dose of vitamin B12 required varies from individual to individual and working with a doctor or naturopathic doctor to determine the correct dose is recommended. Vitamin B12 can be taken orally, by nasal gel or by injection. The best way to take it depends on the underlying cause of the deficiency, so it’s important to be properly assessed before starting supplements. For oral therapy, a typical recommendation is 1,000 to 2,000 mcg daily.

One way to know if supplementation can help you is to do a trial run of vitamin B12 supplementation for at least six to eight weeks. If you are using pills or sublingual lozenges, the most useful form of vitamin B12 is methylcobalamin. Talk to your doctor before starting any new supplement to make sure it is safe for you.

Some people will see improvements after a few days of taking vitamin B12 and may do well taking it in a tablet or lozenge that goes under the tongue. Others will need several months to see results and may need nasal gel or injections for the best improvements. For many people, supplementation has been a very important part of an approach to resolving mental and emotional problems.

Vitamin D

Some studies show that vitamin D deficiency, and often quite severe deficiency, is a common problem in people with HIV. Vitamin D is intimately linked with calcium levels, and deficiency has been linked to a number of health problems, including bone problems, depression, sleep problems, peripheral neuropathy, joint and muscle pain and muscle weakness. It is worth noting that in many of these cases there is a link between vitamin D and the health condition, but it is not certain that a lack of vitamin D causes the health problem.

A blood test can determine whether or not you are deficient in vitamin D. If you are taking vitamin D, the test will show whether you are taking a proper dose for health, while avoiding any risk of taking an amount that could be toxic (although research has shown that toxicity is highly unlikely, even in doses up to 10,000 IU daily when done under medical supervision). The cost of the test may not be covered by all provincial or territorial healthcare plans or may be covered only in certain situations. Check with your doctor for availability in your region.

The best test for vitamin D is the 25-hydroxyvitamin D blood test. There is some debate about the best levels of vitamin D, but most experts believe that the minimum value for health is between 50 and 75 nmol/l. Many people use supplements to boost their levels to more than 100 nmol/l.

While sunlight and fortified foods are two possible sources of vitamin D, the surest way to get adequate levels of this vitamin is by taking a supplement. The best dose to take depends on the person. A daily dose of 1,000 to 2,000 IU is common, but your doctor may recommend a lower or higher dose for you, depending on the level of vitamin D in your blood and any health conditions you might have. People should not take more than 4,000 IU per day without letting their doctor know. Look for the D3 form of the vitamin rather than the D2 form. Vitamin D3 is the active form of the vitamin and there is some evidence that people with HIV have difficulty converting vitamin D2 to vitamin D3. Historically, vitamin D3 supplements are less commonly associated with reports of toxicity than the D2 form.

It is best to do a baseline test so you know your initial level of vitamin D. Then, have regular follow-up tests to see if supplementation has gotten you to an optimal level and that you are not taking too much. Regular testing is the only way to be sure you attain — and then maintain — the optimal level for health.

With proper supplementation, problems caused by vitamin D deficiency can usually be efficiently reversed.

http://nybc.wordpress.com/2013/12/08/why-vitamins-b12-and-d3-are-especially-important-to-people-with-hiv/

Salicylates Found In Aspirin May Reduce Neuropathic Pain

Today's post from herald-review.com (see link below) takes a look at the possibility that Salicylates (most commonly found in aspirin) may be able to help control the symptoms of neuropathy by reducing so-called proinflammatory cytokynes (you're going to need to Google that one - not enough space here). Recent research suggests that Salicylates will target these cytokines, thus reducing  the symptoms that make our lives miserable. It's a short article and interesting but you may need to increase your background knowledge through your own research to understand the science behind it. One thing is sure (and the article emphasises this) you should consult with your doctor or neurologist before taking too much aspirin.

Dear Pharmacist: Salicylates may be key to easing neuropathy
SUZY COHEN For the Herald Review Apr 13, 2016

We take for granted the comfort we feel in our hands and feet, but some people have lost that comfort, and they suffer all day long with strange nerve-related concerns. There is new research about aspirin that could help them; but first, let’s talk about that nerve pain, called “neuropathy.”

Neuropathy feels like you are touching or stepping on pins and needles. It can affect you all over, not just your hands and feet. Depending on various factors (race, age, weight, alcohol consumption, insulin and A1c), your experience of neuropathy may also include pain, vibration or buzzing sensations, lightheadedness, burning sensations (even in your tongue), trigeminal neuralgia or cystitis.

Recognizing what your neuropathy stems from is critical to you getting well. For some, it is due to a vitamin deficiency. For example, vitamin B12 or probiotics that help you to manufacture your own B12 in the gut. For others, it could be that wine you drink with dinner because wine is a potent drug mugger of B1 (thiamine) which protects your nerve coating. By a mile, the most common cause of neuropathy is diabetes.

Approximately half of all people with diabetes experience diabetic neuropathies, mainly in the hands and feet. Some doctors will tell you that maintaining healthy blood glucose will reverse neuropathy but that’s not true, we know from The Diabetes Control and Complications Trial that even intensive glucose control is insufficient to control the risk of diabetic neuropathy.

It’s tough love, but I need to say it: Uncontrolled neuropathy can cause a 25 percent higher cumulative risk of leg amputation. So, gaining control is important for your independence. I’ve written about natural supplements for neuropathy in the past (articles are archived at suzycohen.com), and you can have a free ebook “Spices that Heal” which offers more natural advice (get it by signing up for my email newsletter).

New research was published last March in Current Diabetes Reports. Scientists confirmed that targeting inflammatory cytokines can help relieve diabetic neuropathy. Oftentimes, that bad gateway called NF Kappa B (NFKB) opens its floodgates, and spits out proinflammatory cytokines such as COX-2 (Celebrex lowers this), nitric oxide synthase, lipoxygenase, TNF alpha and a lot of pain-causing interleukins (IL-1β, IL-2, IL-6, IL-8).

The researchers reported that something as simple as salicylate therapy could help reduce some of these cytokines as well as circulating glucose, triglycerides, C reactive protein and free fatty acids. When you think of salicylates, please understand this is a broad group of compounds found naturally in the plant kingdom. Salicylate is the main ingredient in aspirin and other analgesics, both prescribed and over-the-counter. Salicylates include spearmint, peppermint (even in mint toothpaste) and in muscle rubs. White willow bark is an herb that is morphed and turned into aspirin. They’re not right for everyone; so please ask your doctor about salicylates for neuropathy. Also ask if you can have a blood test to evaluate some of the proinflammatory markers I noted above.

Suzy Cohen can be reached at www.SuzyCohen.com

http://herald-review.com/news/opinion/editorial/columnists/dear-pharmacist-salicylates-may-be-key-to-easing-neuropathy/article_0549df7f-5c1b-5987-9900-f629df764099.html

Sometimes No News About Nerve Pain Treatment Is Just As Bad As Fake News!

I have to say that today's post from sciencedaily.com (see link below), which is widely repeated across the internet at the moment, is problematic for me. When you see the words: 'moderate evidence' and 'probably' and 'Unfortunately, more research is still needed', littering an article, you know that what you're reading is more of the same and nothing new. So, we have a report from the esteemed, Agency for Healthcare Research and Quality (AHRQ) which broadly supports the continued use of the anti-depressants and anti-seizure drugs to treat nerve pain we all know and are generally disappointed by but offers no new evidence, or new alternatives, just more vague estimations that these drugs are probably better than nothing. Frankly it's not good enough. People are going to read this in the way that people do and come to the conclusion that pregabalin, duloxetine, gabapentin, amongst others; with botox and capsaicin thrown in for good measure, are all okay for nerve pain. Now, forty years of stagnation in pain control for nerve pain, suggests the opposite. The side effects are so often worse than the symptoms themselves that yet more suffering is heaped upon innocent patients who believe what they read here. Of course, these days, no article of this sort is ever complete without the statutory warning about the evils of opioids (as if sensible opioid users don't already feel guilty enough about taking the only thing that really reduces their pain!). If you look carefully at this story and maybe read some of the other versions that are currently sweeping the neuropathy net, you'll see that while this is not a 'fake news' story, it is a non-news story - we've heard these conclusions for decades - why are they getting so much publicity?

Which drugs effectively treat diabetic nerve pain?
American Academy of Neurology (AAN) Date: March 24, 2017

A federal health agency has found certain antidepressants and anti-seizure drugs are among medications that effectively treat diabetic nerve pain. The research is being published simultaneously in the March 24, 2017, online issue of Neurology®, the medical journal of the American Academy of Neurology (AAN) and in a more comprehensive report by the Agency for Healthcare Research and Quality (AHRQ).


AHRQ is the lead federal agency charged with improving patient safety and the quality of America's health care system.

The Centers for Disease Control and Prevention (CDC) says more than 9 percent of the U.S. population has diabetes and an estimated 50 percent of people with diabetes have some form of diabetic peripheral neuropathy, nerve damage caused by high levels of blood sugar, although not all have symptoms. Symptoms can include nerve pain, numbness and tingling in the legs and feet. The longer someone has diabetes, the greater the risk of developing neuropathy, especially for those who have problems controlling blood sugar. Severe neuropathy may eventually lead to the need to consider amputation.

"Providing pain relief for neuropathy is crucial to managing this complicated disease," said Julie Waldfogel, PharmD, of The Johns Hopkins Hospital in Baltimore, Md., and author of the systematic review. "Unfortunately, more research is still needed, as the current treatments have substantial risk of side effects, and few studies have been done on the long-term effects of these drugs."

A systematic review is an analysis of the results of multiple, carefully designed studies available on a topic.

For this systematic review, researchers looked for studies and other systematic reviews conducted after the American Academy of Neurology's 2011 guideline "Treatment of Painful Diabetic Neuropathy." A total of 106 studies were included in the review.

Researchers found moderate evidence that the antidepressants duloxetine and venlaxine, which act as serotonin-norepinephrine reuptake inhibitors, were effective in reducing neuropathy-related pain.

They also found weak evidence that botulinum toxin, the anti-seizure drugs pregabalin and oxcarbazepine, as well as drugs classified as tricyclic antidepressants and atypical opioids were probably effective in reducing pain.

Waldfogel noted that the long-term use of opioids is not recommended for chronic pain due to lack of evidence of long-term benefit and the risk of abuse, misuse and overdose.

Researchers noted that while pregabalin works in the same way as gabapentin -- both are often used interchangeably in clinical care -- this review found gabapentin was not more effective than placebo. This is contrary to the 2011 AAN guideline, which found gabapentin to be probably effective.

The seizure drug valproate and capsaicin cream, which were considered probably effective in the 2011 AAN guideline, were ineffective in this meta-analysis.

"We hope our findings are helpful to doctors and people with diabetes who are searching for the most effective way to control pain from neuropathy," said Waldfogel. "Unfortunately, there was not enough evidence available to determine if these treatments had an impact on quality of life. Future studies are needed to assess this."

There were other limitations. One was that all studies were short-term, less than six months, and all studies on effective drugs had more than 9 percent of participants drop out due to adverse effects. Longer-term outcomes should be evaluated in future studies so that side effects and continued effectiveness of the drugs can be assessed.

Story Source:

Materials provided by American Academy of Neurology (AAN). Note: Content may be edited for style and length.

Journal Reference:
Julie M. Waldfogel, Suzanne Amato Nesbit, Sydney M. Dy, Ritu Sharma, Allen Zhang, Lisa M. Wilson, Wendy L. Bennett, Hsin-Chieh Yeh, Yohalakshmi Chelladurai, Dorianne Feldman, Karen A. Robinson. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology, 2017; 10.1212/WNL.0000000000003882 DOI: 10.1212/WNL.0000000000003882
 
https://www.sciencedaily.com/releases/2017/03/170324192328.htm

I know exactly what he means!

A video from a blog entitled,Diabetic Neuropathy whats it all about hey! from a guy named Clayton. (Be patient, he's not the fastest speaker in the world but there will be many who can totally identify with what he says)

TICKLING YOUR EAR COULD BE GOOD FOR YOUR HEART

Stimulating nerves in your ear could improve the health of your heart, researchers have discovered. A team at the University of Leeds used a standard TENS machine like those designed to relieve labour pains to apply electrical pulses to the tragus, the small raised flap at the front of the ear immediately in front of the ear canal.

The stimulation changed the influence of the nervous system on the heart by reducing the nervous signals that can drive failing hearts too hard.

Professor Jim Deuchars, Professor of Systems Neuroscience in the University of Leeds' Faculty of Biological Sciences, said: "You feel a bit of a tickling sensation in your ear when the TENS machine is on, but it is painless. It is early days -- so far we have been testing this on healthy subjects -- but we think it does have potential to improve the health of the heart and might even become part of the treatment for heart failure."

The researchers applied electrodes to the ears of 34 healthy people and switched on the TENS (Transcutaneous electrical nerve stimulation) machines for 15-minute sessions. They monitored the variability of subjects' heartbeats and the activity of the part of the nervous system that drives the heart. Monitoring continued for 15 minutes after the TENS machine was switched off.

Lead researcher Dr Jennifer Clancy, of the University of Leeds' School of Biomedical Sciences, said: "The first positive effect we observed was increased variability in subjects' heartbeats. A healthy heart does not beat like a metronome. It is continually interacting with its environment -- getting a little bit faster or a bit slower depending on the demands on it. An unhealthy heart is more like a machine constantly banging out the same beat. We found that when you stimulate this nerve you get about a 20% increase in heart rate variability."

The second positive effect was in suppressing the sympathetic nervous system, which drives heart activity using adrenaline.

Dr Clancy said: "We measured the nerve activity directly and found that it reduced by about 50% when we stimulated the ear. This is important because if you have heart disease or heart failure, you tend to have increased sympathetic activity. This drives your heart to work hard, constricts your arteries and causes damage. A lot of treatments for heart failure try to stop that sympathetic activity -- beta-blockers, for instance, block the action of the hormones that implement these signals. Using the TENS, we saw a reduction of the nervous activity itself."

The researchers found significant residual effects, with neither heart rate variability or sympathetic nerve activity returning to the baseline 15 minutes after the TENS machine had been switched off.

The technique works by stimulating a major nerve called the vagus, which has an important role in regulating vital organs such as the heart. There is a sensory branch of the vagus in the outer ear and, by sending electrical current down the nerves and into the brain, researchers were able to influence outflows from the brain that regulate the heart. Vagal nerve stimulation has previously been used to treat conditions including epilepsy.

Professor Deuchars said: "We now need to understand how big and how lasting the residual effect on the heart is and whether this can help patients with heart problems, probably alongside their usual treatments. The next stage will be to conduct a pre-clinical study in heart failure patients."

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Testing Pain Are You Believed

Today's excellent post from vox.com (see link below) talks about something that many people living with neuropathy are very much aware of and that is how their doctors perceive their pain experience. The feeling that you're not believed, or taken seriously, is far too common and it comes down to the fact that the methods of testing pain are inherently deficient. The article looks at what it's like to be disbelieved and then goes on to explore new possibilities of more accurate pain testing, with an emphasis on brain imaging, which may be very helpful in the future. Well worth a read.
 

The pain test
Doctors have no idea how much their patients are suffering. That's about to change. 
by Susannah Locke on October 15, 2014

Ally Niemiec could have lost a kidney because doctors didn't believe she was in pain. It was last fall, and one of at least a dozen times that her rare kidney disease had sent her to the emergency room. She recognized the pain. She knew something was wrong.

But when she turned up in an Atlanta emergency room that Saturday afternoon, vomiting and doubled over, no one believed her. They looked at her pain medication records and decided she had a drug abuse problem.

"They told my mother that I needed to go to rehab and was a drug addict," she says. The hospital wouldn't give her any narcotic pain medication and refused to do an x-ray, ultrasound, or CT scan.

That time, Niemiec was lucky enough to have other options. She left for another hospital, where they treated her pain and then removed her kidney stone the next morning.

This discouraging experience was nothing new. For many years, she was used to doctors not trusting her. "There's nothing more horrific than a doctor looking you in the eye and saying there's nothing wrong with you when you're in debilitating pain"

One problem has been that her kidney disorder, renal tubular acidosis type 1, is described in medical journals as not painful. But to her, it was. Since she was 13, she's had about 100 kidney stones and 18 surgeries to remove them. At one point, her pain was so bad that she couldn't drive and had to leave her job. She went from doctor to doctor trying to get help. When her pain got really bad, she didn't find adequate treatment for three long years.

"There's nothing more horrific than a doctor looking you in the eye and saying there's nothing wrong with you when you're in debilitating pain," she says. "To me, it's a form of torture."

Eventually, she got a spinal cord implant that uses electrical signals to block her kidney pain. Now she's 24 years old and works at a tech startup. But many others continue to suffer.

Approximately 100 million Americans have chronic pain. That's about a third of the population. Yet the most cutting-edge test for pain is a doctor holding a piece of paper with a bunch of frowny and smiley faces on it or asking you how bad you feel on a scale of 1 to 10, with ten as the worst pain imaginable. It seems a much better test of imagination than of pain.




And as Niemiec can attest, the subjectiveness of the scale causes problems — it only works if the doctor believes you, and relying only on trust can threaten people's lives.

There must be a better way to test if someone is in pain. "That would completely have changed my experience," Niemiec says. "It could have saved me three years of my life."

Right now, such a test doesn't exist. But it's looking likely that it might someday soon. In several key studies, scientists have used brain-scanning machines to accurately predict if someone is in pain.

A more objective pain test could transform pain medicine and lead to new treatments for people who suffer. It could weed out people lying in order to get drugs. And it could prove to doctors that people like Niemiec are really in pain.

But this new technology also raises all kinds of ethical and legal questions. It might also end up as faulty mind-reading that could be used to deny care and insurance coverage to those who are truly in distress.
What is pain?

"Pain is so wonderful because it is so bad," says Sean Mackey, the chief of pain medicine at Stanford's medical school, who was the first to show that pain can be gauged using a brain scan. "It keeps us out of harm and out of danger."

Mackey's right: pain teaches people to stay away from hazards and tells them when they're injured or sick. It trains us to keep our hands away from hot stoves. It lets us know when our appendix has burst. Or when we're having a heart attack. Pain is so important that people who cannot feel pain encounter repeated injuries and have shorter life spans.

Despite pain's importance, it is quite difficult to define. And that difficulty underlies much of the disagreement about whether objective pain testing is even possible.

Today, pain is understood as a type of subjective experience. The International Association for the Study of Pain states that pain is "An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage."

So although the mechanisms for what usually causes pain — certain receptors on certain neurons — are fairly well known, pain is still not defined as a physical thing that your body does. Your neurons could be firing off pain signals like crazy, but as long as you don't feel pain (like if you've popped an Advil or are under anesthesia), you're not in pain. If you feel pain, you are in pain.


But brain imaging can put an image to the invisible.
It can give them something to see. 

Why the world needs a better pain test

Mackey, the Stanford pain specialist, got his PhD in electrical engineering and also an MD. "Coming out of medical school, you probably couldn't find anyone more mechanistic or linear in their thinking than me," he says. "I ended up going into pain medicine because I was intrigued about the opportunities of really making a difference in people's lives."

Working with pain patients, he often found himself using needles to block pain. (One common treatment for chronic pain is a temporary injection of anesthetic into the body, which stops pain signals from reaching the brain.) But it wasn't working for everyone. "There was large numbers of people that I wasn't helping with that approach," he says. "What really was helping them was listening to them, hearing about their fears, their anxieties, their beliefs about their pain."

Those observations got him interested in the brain side of things, the psychology side, and how things like anxiety, fear, and empathy influence pain. "It was around this time that this field of neuroimaging was being established, which allows us to open up windows into people's brains to see where pain is processed and perceived."

He wanted to use the technology to learn about how people experience pain differently and how thoughts and emotions affect pain, hoping to be able to better tailor therapies to people for better treatment. Along the way, it began to seem possible to create a test that would correlate with someone's pain levels.

A pain test could help all kinds of people. One main group is those who can't speak for themselves. For example, even into the 1980s, some doctors didn't believe that babies felt pain and so routinely did surgery on them using just muscle relaxants to keep them still. And today, some people can't tell others what they're feeling, including small children, some adults with developmental disorders, and people in coma.

And even among people who can communicate fully, not everyone's word is regarded as truth. Researchers have documented discriminatory patterns in how health-care workers treat pain. Women are more likely to have their pain dismissed as not real. And one study found that female emergency room patients with abdominal pain were less likely to be given strong pain meds than men were. Papers have found similar phenomena for racial minorities.

And until the last couple of decades, doctors thought that many people with chronic pain were faking it. Roger Fillingim is a psychologist at the University of Florida who studies pain. He describes patients saying that just the feeling of a long-sleeved shirt on their arm was painful: "We used to call that crazy." Now, doctors know that a lot of chronic pain is actually real. For example, fibromyalgia, which causes pain throughout the body, was in the crazy category, too. Now it's known to affect roughly 15 million people in the United States.
The problems with pain medication

Drug abuse is another reason a better pain test could come in handy. That abuse has led narcotic painkillers to become more tightly controlled in recent years, sometimes so tightly that people with real pain problems have trouble getting their medication.

There's no question that there's a prescription-drug abuse problem in this country. Each year, more people die in the United States from prescription painkillers than from heroin and cocaine combined. And some, but not all, of the people abusing these drugs are people who do not have an actual pain problem.

One recent review on the topic found that about 20 percent of chronic pain patients given opiate drugs long-term had either none of the drug or a non-prescribed opiate in their urine during screening tests, which suggests that they might be selling or giving the drugs away rather than taking them responsibly. (The study also found that very few — 3 percent — of all of the patients personally ended up with an addiction or abuse problem related to these drugs. If patients with a history of drug abuse are excluded, this number drops below one percent. However, screening people out doesn't always happen in today's hectic health-care environment.)

It's difficult to balance what regulations will get pain meds to patients who need them while keeping them from people who don't. You can see where these objectives collide in the recent battle over Zohydro ER. This new drug is an extended-release version of the opiate hydrocodone and the only hydrocodone for sale without another drug in it.

It's also somewhat analogous to OxyContin, which became a preferred drug of abuse in the late 1990s and early 2000s — at least until 2010, when its manufacturers made OxyContin difficult to snort or inject, with pills that were hard to crush and that turn into a gel when wet. "If you could somehow measure pain, would that be helpful? It would be helpful to me because I want to know if my patients are legitimate."

However, Zohydro ER, like every opiate on the market except for OxyContin, has no such anti-abuse features built into its pill. For some with chronic pain, it's their only chance for relief. To others, it's death in a bottle.

In October 2013, the FDA approved Zohydro ER against the recommendation of its independent advisory panel. In the spring of 2014, Massachusetts governor Deval Patrick banned it, but a judge struck the ban down just a month later. And in August, several governors petitioned the US Department of Health and Human Services to undo the decision.

Concerns about abuse have also led to changes in regulation and enforcement that pressure doctors, wholesalers, and pharmacists to give out fewer narcotic painkillers.

For example, in Florida, crackdowns to combat a previously growing problem with pain-medication deaths has made it difficult for legitimate pain patients to actually get their prescribed medication, says Jeffrey Fudin, a pharmacist who specializes in pain treatment and is an adjunct associate professor at Western New England University.

A better pain test is one thing that could help real pain patients prove themselves — and weed out the liars. "If you could somehow measure [pain] would that be helpful? It would be helpful to me because I want to know if my patients are legitimate," Fudin says.
The research on brain imaging

Recent advances in brain-imaging technology have shown that the mind's secrets are sometimes surprisingly readable. For example, some researchers have used brain scanning to guess with some accuracy what shapes people are looking at or what type of object they were dreaming of: a building, a car, a person.

The main technique researchers are using is functional magnetic resonance imaging, or fMRI. An fMRI machine employs a giant magnet that can read where blood is in the brain. And because blood flows more to active brain areas, an fMRI scan can measure brain activity.

In the past few years, researchers have published studies showing that fMRI could determine whether someone is in pain.

In 2011, in a small study of 24 people, Mackey's group used advanced computer algorithms to show whether someone was receiving a painfully hot stimulus to his or her forearm with 81 percent accuracy. The observed differences in brain activity weren’t clustered in only one area, but in many, many places across the entire brain.
A pain test could help all kinds of people. One main group is those who can't speak for themselves.

In 2013, a paper led by Tor Wager, a neuroscientist at the University of Colorado Boulder, confirmed those findings in a bigger study published in a very prestigious journal: The New England Journal of Medicine. It involved 114 participants and correctly guessed whether someone was in pain about 95 percent of the time. Even more impressive was that the brain patterns seemed somewhat universal — that is, the algorithms were developed on one set of volunteers and then worked on another set that had never been scanned before.

Then in 2014, Mackey published another paper that looked at patients with chronic back pain, using still MRI images to examine brain structures rather than brain activity. He was able to produce an algorithm that guessed with 76 percent accuracy whether or not a brain was from a chronic back pain patient. A similar study published the same year identified people who had chronic pelvic pain with 73 percent accuracy.

Still images of brain structure like these could someday help chronic pain patients justify their condition, even though they don't show brain activity itself.

All of these new studies are still firmly in the realm of science, not medicine. These tools are not ready for use on patients to determine a course of treatment. Mackey estimates that that might be 10 years away.

The tests can't yet accurately predict someone's exact level of pain. And they've only been demonstrated within the confines of well-controlled laboratory studies.

In addition, most researchers don't believe that there's just one pain brain-activity pattern, but that different kinds of pain will end up producing different patterns. So, touching something hot might look different than the muscle pain of fibromyalgia, which might look different than chronic back pain. And that means that a lot more research will be needed before such technology could be used on the wide variety of painful health issues that exist.
The problems with an 'objective' pain test

Both Mackey and Wager see a lot of potential in using brain imaging as a research tool to better understand the various causes and types of pain — and to develop new ways to treat it. They think that such scans should only be used to confirm someone's pain, but never to go against their word and deny that they're in pain when they say that they are. That's because pain is defined as a subjective experience. And the brain scan is objective. So, to them, the brain scan is merely an objective marker of possible pain.

Another reason for that stance is that a person could be feeling a kind of pain that they haven't found the brain signature for yet. "It might not look like other people's pain, but it might be their pain," says Wager.

And, says Mackey, "There is the potential for abuse. There's always the potential for people misusing this technology for insurance purposes to deny care."

However, both researchers do support using the technology someday on people who can't say if they're in pain or not, like babies or some people with developmental disabilities. Because any evidence is better than nothing at all.

Another problem is that pain might be something that cannot be reduced to a bunch of neurons firing. "Some people believe that pain isn't simply some sum or algorithm of brain activity, it's an emergent property of brain activity," says Fillingim. "And maybe we won't figure out how the experience of pain emerges from some pattern of brain activity. And maybe the formula is different for different people."

"Could we similarly look at someone's brain and tell you how happy they are, how satisfied with life?" he asks. "These are all pretty high level experiences."

Another problem could come from brain-scan pain tests getting used in court. Some people approximate that awards for pain and suffering make up about half of personal injury damage awards. So there's big money on the line. "The legal system has a tremendous need for more objective ways of measuring pain," says Adam Kolber, a professor at Brooklyn Law School who has written extensively about the future ethical and legal implications of pain testing. "There is the potential for abuse. There's always the potential for people misusing this technology for insurance purposes to deny care."

He's not that concerned about how pain tests will be used in the long run. He notes that there are standards in place to stop new technology from becoming admissible evidence until it's fully developed. And he focuses on the positive side of what the technology could do: "This is a possibility of better compensating people who are in pain. I think that's promising."

But not everyone agrees. And Mark Sullivan is one of them. He's a psychiatrist and bioethicist at the University of Washington who specializes in treating patients with chronic pain. He's been one of the most vocal opponents of the drive to find objective measures of pain.

He's debated both Mackey and Wager in person at pain research meetings and debated on paper in the Journal of Pain in 2013. And he says he's concerned about people who are truly ill being denied workers' compensation and social security because nothing can be found on a brain scan: "You could easily see a situation where someone says, ‘Well, I can't work because I have terrible back pain.' And you stick them in an MRI scanner and it's ‘I don't see any evidence that you're in pain. So we're not going to give you disability payments anymore.'"

Whether it leads to good or bad outcomes, computing power, fMRI resolution, and data from patients will keep increasing. Technology will march on, and someday, someone is going to start selling something called an objective pain test, whether or not that's actually what it's capable of.

And no matter how accurate the test is or isn't, the images it produces could help pain become a more visible problem in health care. Pain isn't something that someone can see, like a physical wound. It can take numerous forms, making it easier for medical practitioners to ignore.

44-year-old Californian Elizabeth Schenk is one of the many patients who've had doctors ignore her agony. She used to be a pilates instructor, but her chronic pain has brought her into a new career counseling people with pain problems. At its worst, her pain has been excruciating: "like someone was dragging a knife down my thigh," and "like someone taking a hammer to my thumb," and "a chisel to my spine."

"What I've experienced in the medical world is that if they don't see anything, they won't do anything," she says. But brain imaging can put an image to the invisible. It can give them something to see.

http://www.vox.com/2014/10/15/6895171/how-doctors-measure-pain-brain-scan-fmri