BRAIN DIFFERENCE SOMETIMES ADOLESCENTS JUST CANT RESIST

Don't get mad the next time you catch your teenager texting when he promised to be studying. He simply may not be able to resist

A University of Iowa study found teenagers are far more sensitive than adults to the immediate effect or reward of their behaviors. The findings may help explain, for example, why the initial rush of texting may be more enticing for adolescents than the long-term payoff of studying.

"The rewards have a strong, perceptional draw and are more enticing to the teenager," says Jatin Vaidya, a professor of psychiatry at the UI and corresponding author of the study, which appeared online this week in the journal Psychological Science. "Even when a behavior is no longer in a teenager's best interest to continue, they will because the effect of the reward is still there and lasts much longer in adolescents than in adults."

For parents, that means limiting distractions so teenagers can make better choices. Take the homework and social media dilemma: At 9 p.m., shut off everything except a computer that has no access to Facebook or Twitter, the researchers advise.

"I'm not saying they shouldn't be allowed access to technology," Vaidya says. "But they need help in regulating their attention so they can develop those impulse-control skills."

In their study, "Value-Driven Attentional Capture in Adolescence," Vaidya and co-authors Shaun Vecera, a professor of psychology, and Zachary Roper, a graduate student in psychology, note researchers generally believe teenagers are impulsive, make bad decisions, and engage in risky behavior because the frontal lobes of their brains are not fully developed.

But the UI researchers wondered whether something more fundamental was going on with adolescents to trigger behaviors independent of higher-level reasoning.

"We wanted to try to understand the brain's reward system and how it changes from childhood to adulthood," says Vaidya, who adds the reward trait in the human brain is much more primitive than decision-making. "We've been trying to understand the reward process in adolescence and whether there is more to adolescent behavior than an under-developed frontal lobe," he adds.

For their study, the researchers recruited 40 adolescents, ages 13 and 16, and 40 adults, ages 20 and 35. First, participants were asked to find a red or green ring hidden within an array of rings on a computer screen.

Once identified, they reported whether the white line inside the ring was vertical or horizontal. If they were right, they received a reward between 2 and 10 cents, depending on the color. For some participants, the red ring paid the highest reward; for others, it was the green. None was told which color would pay the most.

After 240 trials, the participants were asked whether they noticed anything about the colors. Most made no association between a color and reward, which researchers say proves the ring exercise didn't involve high-level, decision-making.

In the next stage, participants showed they had developed an intuitive association when they were asked to find a diamond-shaped target. This time, the red and green rings were used as decoys.

At first, the adolescents and adults selected the color ring that garnered them the highest monetary reward, the goal of the first trial. But in short order, the adults adjusted and selected the diamond. The adolescents did not.

Even after 240 trials, the adolescents were still more apt to pick the colored rings.

"Even though you've told them, 'You have a new target,' the adolescents can't get rid of the association they learned before," Vecera says. "It's as if that association is much more potent for the adolescent than for the adult.

"If you give the adolescent a reward, it will persist longer," he adds. "The fact that the reward is gone doesn't matter. They will act as if the reward is still there."

Researchers say that inability to readily adjust behavior explains why, for example, a teenager may continue to make inappropriate comments in class long after friends stopped laughing.

In the future, researchers hope to delve into the psychological and neurological aspects of their results.

"Are there certain brain regions or circuits that continue to develop from adolescence to adulthood that play role in directing attention away from reward stimuli that are not task relevant?" Vaidya asks. "Also, what sort of life experiences and skill help to improve performance on this task?"

The study was funded by the University of Iowa's Social Sciences Funding Program.

Just How Effective Are Opioids In Neuropathy Treatment

Today's post from medpagetoday.com (see link below) is an interesting review of a large-scale study of the effects of opioid treatment on people with neuropathy. It concludes that opioid use has its limitations but there is no evidence that it is either, over-prescribed by doctors, or abused by patients. This removes it immediately from the current hysteria concerning opioid medication and recognises that people with severe neuropathy have very few options. As a result, it calls for new medication development, not to remove the 'evils' of opioids but to provide a better alternative for patients in chronic pain. Definitely worth a read though maybe a little disheartening for people who rely on opioids to dampen their symptoms, having already exhausted all other options.

Long-Term Opioids May Not Help in Polyneuropathy
by Kristin Jenkins Contributing Writer, MedPage Today May 23, 2017 Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner last updated 05.23.2017
 
Action Points

Long-term opioid therapy among patients with polyneuropathy appears to increase the risk of adverse outcomes without benefiting functional status, according to a retrospective population-based study.
Note the data agree with prior studies showing opioid use disorders are more prevalent among those receiving long-term opioid therapy, but did not indicate that long-term opioid therapy significantly increases mortality among patients with polyneuropathy as it does among broader populations of patients reported elsewhere.


Long-term opioid therapy in patients with polyneuropathy appears to increase the risk of adverse outcomes without benefiting functional status, researchers said.

Data from a retrospective, population-based cohort study showed that 18.8% of 2,892 patients with polyneuropathy received opioids continuously for at least 90 days compared to 5.4% of 14,435 controls. They were also more likely to rely on gait aids and have difficulty climbing stairs (adjusted HR 1.7) and experience depression (adjusted HR 1.53), opioid dependence (aHR 2.85), and opioid overdose (aHR 5.12) compared to controls, Christopher J. Klein, MD, of the Mayo Clinic in Rochester, Minn, and colleagues reported online in JAMA Neurology.

"By showing that polyneuropathy increases the risk of long-term opioid therapy and that long-term opioid therapy is not associated with improved functional status but is associated with adverse outcomes, this study provides useful information to counsel patients with polyneuropathy who are considering or are already receiving opioid therapy," the researchers said. "Furthermore, it provides evidence that could influence treatment guidelines and health policy."

The researchers also reported that a diagnosis of opioid abuse among patients with polyneuropathy who were taking opioids for any length of time was observed in less than 2% of patients and that there was no significant association with overall mortality. However, there was a 7.2% rate of opioid dependence and a 2.6% rate of opioid overdose, they pointed out, adding that this "underscores that abuse and dependence are not synonymous."

"Thus, our results agree with those of prior studies citing that opioid use disorders are more prevalent among those receiving long-term opioid therapy, but we did not find that long-term opioid therapy significantly increases mortality among patients with polyneuropathy as it does among broader populations of patients reported elsewhere.

Importantly, the study also showed that neurologists and pain physicians were only prescribing long-term opioid therapy in a small percentage of patients, a finding consistent with national trends, the researchers noted. "Therefore, it is likely that discussing potential benefits, as well as adverse outcomes, of long-term opioid therapy will fall to the primary care clinician," Klein and colleagues said.

For the study, the Rochester Epidemiology Project (REP) database was searched for prescriptions given to patients with polyneuropathy and for those given to controls in ambulatory practice. All data came from participants who resided in Olmsted County from Jan. 1, 2006, to Dec. 31, 2010 and were reported previously. The latest follow-up ended Nov. 25, 2016.

Patients with polyneuropathy receiving 90 days or more of opioid therapy were more likely to be female (57%) than those receiving short-term opioid therapy (P<0 .001="" 46="" 69="" age="" also="" although="" between="" br="" common="" commonly="" differences="" documented="" for="" groups="" in="" indication="" long-term="" median="" most="" musculoskeletal="" no="" of="" opioid="" oxycodone="" p="0.13)." pain="" patients="" polyneuropathy="" prescribed="" prescribing="" significant="" similar="" starting="" the="" therapy.="" there="" trends="" two="" versus="" were="" with="" xycontin="" years="">
Although rates of lower limb complications were comparable between the two groups, patients with polyneuropathy used non-opioid analgesics more often than controls.

In an accompanying editorial, Nora Volkow, MD, of the National Institute on Drug Abuse, and Walter Koroshetz, MD, of the National Institute of Neurologic Disorders and Stroke, noted that opioids in this study were prescribed more often for treatment of non-neuropathic indications. However, this finding doesn't change the evidence behind current guidelines advising against opioids as first-line treatment in most cases of neuropathic pain because of long-term safety concerns, they said.

The study also highlights the limited alternatives for managing chronic pain, and the urgent need to develop new medications, the editorialists said. Recent work in animal models demonstrate that innovative opioid peptides and biased opioid agonists may provide equivalent pain relief with less tolerance and fewer adverse effects while success with biologics for inhibiting pain at the its source may shift the focus to prevention, they said.

"In the meantime, structural changes in the healthcare system, including training of physicians in the screening and management of pain, as well as coverage by insurance of comprehensive pain management programs, are needed to ensure that patients receive the most effective treatments for their chronic pain conditions," Volkow and Koroshetz said.

Limitations of the study include the fact that it was based on prescription data without confirmation that prescriptions were filled or taken as intended.


This study was funded by the Mayo Foundation for Medical Education and Research, Mayo Clinic Center for Individualized Medicine, and the National Institutes of Health (NIH). The study authors disclosed no conflicts of interest. The editorialists disclosed no funding or conflicts of interest.

https://www.medpagetoday.com/neurology/painmanagement/65497

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