Learning To Cope With Neuropathic Pain Or Popping A Pill

Today's post from instituteforchronicpain.org (see link below) is an excellent article about how chronic pain is treated. It talks about the modern emphasis on quick-fix cures and medications and bemoans the fact that not more emphasis is laid on learning how to cope with pain problems instead of just popping pills. As someone living with neuropathy, you will be aware that we are on the edge of this argument. Neuropathy symptoms can be so acute and long-lasting that we'll give anything for a pill to take them away and for many of us, that's indeed what we're prescribed but we also realise that techniques concerning coping with the pain can be equally important and valuable. The problem is that this involves another specialist, or therapist and most doctors need to get you out of the surgery as quickly as possible - not deliberate but a sign of the times where time pressure and costs are paramount. If we try to find coping solutions for ourselves, we're often confronted with 'new age' clichés that urge us to do things our rational minds agree with but are often impractical and vague. This article calls for more attention on coping therapies from the medical establishment and quite rightly so. Worth a read.
 

Coping: Ideas that Change Pain
Author: Murray J. McAllister, PsyD Posted on October 30, 2015

Coping-based healthcare is often misunderstood in society and, as a result, it is commonly neglected by healthcare providers and patients alike. Examples of such care are chronic pain rehabilitation for pain disorders, cardiac rehabilitation for heart disease, psychotherapy for mental health disorders, or diabetic education for diabetes. These therapies are often the last thing that healthcare providers recommend or the last thing people are willing to try, even though they are typically some of the most effective treatments for their respective conditions.

This misunderstanding and neglect is likely due to a number of reasons. Our healthcare system is set up for providers to focus on making patients well, not teaching them how to become well or get better at dealing with a health problem that won’t go away, such as chronic health conditions.

Another reason may be our shared desire for a quick fix. Understandably, when faced with a health problem, we often initially want something that will take it away, rather than coming to terms with the need to change our lifestyle in order to get healthier or become more effective at coping with the problem that we face.

Yet another reason is our societal misunderstanding of the role that genetics play in most of these chronic conditions. It’s not uncommon for people to report that their depression or back pain or heart disease or type II diabetes runs in their family, as if to say, there really isn’t much they can do about it. To be sure, at least some of these conditions, if not all of them, run in families, but a genetic predisposition is not destiny or fate. In all these conditions, the lifestyle choices we make in our lives also play a role and it’s healthy changes in how we live our lives that can make all the difference.

There’s also something about going to see a healthcare provider to learn how to be healthier that just doesn’t seem as real or effective as going to see a healthcare provider for a medication or a high-tech test or an injection or a surgery. Coping-based care, in other words, seems so intangible. Acute medical care is something that you can touch, see, hear, even smell at times. You walk away with medications in your hand, a dull ache at the site of where you got the injection, or a hospital wristband. Such tangibles are missing when you see your rehabilitation provider or your psychotherapist or your diabetic educator. You walk away with nothing but ideas on how to make healthy changes in your life. In other words, what you walk away with is all in your head.

Speaking of which, yet another reason why coping-based therapies get short shrift in our healthcare system is stigma. We all might intellectually acknowledge that we could make healthier choices in our lives or deal better with the chronic conditions that we have, but hardly anyone ever wants to openly acknowledge it to others for fear of being blamed. In the face-to-face encounter of the examining room, healthcare providers too typically have a hard time bringing up the fact that, say, a particular patient could benefit from learning how to cope better with his or her problems. The act of bringing it up implies a judgment that the patient isn’t coping well and it’s a sensitive topic. People can become upset. Healthcare providers, despite all their training, are just people too and they become nervous in such situations, often too nervous, and so the whole topic never gets raised. It’s easier to focus on the tangibles – the medications, tests, injections, and surgeries. Even if the need for learning better coping strategies does get brought up, it’s not uncommon for patients to refuse it, asserting instead that they actually cope really well, despite evidence to the contrary. It can seem advantageous to deny that you are coping poorly when, in our society, coping poorly is a judgeable offense.

For any or all these reasons, coping-based therapies are commonly considered an after-thought, after the ‘real’ healthcare has been tried and failed. It’s too bad because these therapies can be highly effective.

In an ideal (i.e., stigma-free) world, these therapies would be able to stand on their own and be recognizable as the effective therapies that they are. However, we don’t live in such a world.

All of us need to do our part to promote these therapies so that people who need them gain the liberty to use them and become healthier and happier. That’s what’s really at stake here: because of stigma and ignorance and fear, we as a society don’t readily feel free to utilize treatments that can make us healthier and ultimately happier people, even when we experience health problems that can’t entirely be cured.

To this end, at the Institute for Chronic Pain, we make every effort to promote the legitimacy and effectiveness of coping-based rehabilitation treatments for pain. Using common, everyday language, we develop explanations of them that show how and why they can be helpful. We persistently discuss issues related to stigma, particularly how to respond to it so that people can overcome the sensitivity that comes along with openly acknowledging the need to learn how to cope better with the pain that remains chronic on a life-long basis. We then use social media as a means to proliferate these ideas and make them known on an international scale. In short, we promote ideas that change pain.

Our latest effort in this regard is a new content page on our home website. It’s on the nature of coping and how learning to cope better with pain is one of the most powerful interventions we have in the field of chronic pain management.

We hope that you find it helpful. If you do, please pass it on within your social network. Take the risk to acknowledge that there’s nothing wrong with learning how to cope better with a health problem that can’t entirely be cured. You might just help someone else find the help they need.

Date of last modification: 10-30-2015

http://www.instituteforchronicpain.org/blog/coping-ideas-that-change-pain/

A PILL FOR OBESITY

Harvard Stem Cell Institute (HSCI) researchers have taken what they describe as "the first step toward a pill that can replace the treadmill" for the control of obesity, though that shift, of course, would not provide all of the many benefits of exercise.

HSCI principal faculty member Chad Cowan and his team members at Harvard University and Massachusetts General Hospital (MGH), a Harvard affiliate, say they have created a system using human stem cells to screen for compounds that have the potential to turn white, or "bad," fat cells into brown, or "good," fat cells, and have already identified two compounds that can accomplish that in human cells.

The path from these findings to a safe and effective medication may not be easy, and the findings will have to be replicated by other research groups, as well as refined, before they could lead to a clinical treatment.

However, Cowan said that the two compounds discovered so far "target the same molecule, and that molecule plays a role in the inflammatory response. So if you administered them for a long time, the person taking them could become immune-compromised," which argues against the use of these initial compounds without modifications. One, however, is already on the market, as a treatment approved by the U.S. Food and Drug Administration for rheumatoid arthritis.

White fat cells store energy as lipids and play a role in the development of obesity, type 2 diabetes, and related conditions, including heart disease, while brown fat has been shown in mice to lower triglyceride levels, reduce the insulin resistance associated with type 2 diabetes, and burn white fat.

When the body takes in excess energy, it is stored as lipids in white fat cells. When there are too many calories coming in and not enough burned, adult stem cells in the body produce more white fat cells, adding to a person's burden of fat.

Cowan's group has found two small molecules that convert fat stem cells, which normally would produce white fat, into brown-like fat cells. These brown-like fat cells burn excess energy and thereby reduce the size and numbers of white fat cells.

The report by Cowan, an associate professor in Harvard's Department of Stem Cell and Regenerative Biology, and colleagues was released online earlier today by the journalNature Cell Biology. Annie Moisan, a postdoctoral fellow in Cowan's lab, is the lead author of the study.

Cowan said that what "we were really impressed by is that there are some compounds that have this same kind of effect when they are administered to animals, but when you remove them, the effect goes away. But what we saw here was a stable conversion" of white fat cells to brown cells.

"You're constantly replenishing your fat tissue," Cowan explained, "so if you were on a medication to convert the cells, each new fat cell would be more metabolically active and would convert to brown fat over time," reducing the likelihood of developing type 2 diabetes or any of the other conditions related to a buildup of fat.

A former postdoctoral fellow in HSCI co-director Doug Melton's Harvard lab, Cowan began working with fat cells more than seven years ago, when he established his own lab, which originally was in the MGH Center for Regenerative Medicine. "I wanted to use stem cell-derived fat for this purpose and to understand aspects of type 2 diabetes and obesity, which my lab still does," Cowan said.

But the path to this point has been a long one. Cowan said that while there were reports in the literature of research groups producing fat cells from stem cells, "we couldn't get any of those protocols to work. So we had to spend the first three or four years perfecting the protocols to produce white and brown fat cells."

The current findings resulted from a sponsored research collaboration with drug giant Roche Pharmaceuticals, Cowan said, but "unfortunately, the collaboration with Roche has ended because the company decided, for unrelated reasons, to end its metabolic disease program."

"We found these two compounds by screening a library of about 1,000 compounds," Cowan said, "so we know that if we have access to the typical pharmaceutical company library of 1.5 to 2 million compounds, we will find others." Cowan is currently in discussion with several pharmaceutical companies about continuing the work. Additionally, a collaborator in Germany has been testing the first two compounds on mice. "We expect to have results fairly soon," Cowan said, adding that, "The compounds appear to work the same way in mice, but we don't know what the long-term metabolic or immune system effects are

"This is the kind of thing we expected the formation of HSCI" a decade ago to lead to, Cowan said. "The good news/bad news is that science is slow. Just establishing proof of concept takes an enormous amount of time. We thought that working with stem cells would lead to the discovery of new drugs and therapies, and now it's really starting to happen. A decade of hard basic scientific work is paying off."