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Tag "pain"

Childhood abuse or neglect was reported by 58% of 1,348 migraine sufferers according to a study published in the current issue of Headache.  Emotional abuse and neglect was particularly common.  Patients with other chronic pain conditions also have high incidence of emotional, sexual, and physical abuse.  Migraine patients who suffered abuse are also more likely to have anxiety and depression.  We do not know what physiological mechanisms that are triggered by abuse lead to chronic pain.  This and similar studies suggest that greater attention should be directed at the psychological factors that contribute to migraine headaches.  One possible negative outcome of this study is that some physicians, who may already consider migraine to be a purely psychological disorder, will be even more inclined to avoid treating migraine as a biological disease.  In practice, it means that these doctors will be even more reluctant to prescribe appropriate acute migraine medications, such as triptans (Imitrex and other).  Migraine is clearly a biological disorder with documented genetic predisposition and should be treated as such.  At the same time, we know that psychological factors play a major contributing role and should be also addressed when treating headache and pain patients.

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Acupuncture increases connections between different areas of the brain, according to Dhond and other Korean researchers who published their findings in the journal Pain.  They compared the effect of true and sham acupuncture in healthy volunteers using functional MRI of the brain.  They discovered that true acupuncture (insertion of one needle into the forearm) enhanced the “spacial extent of resting brain networks to include anti-nociceptive (pain-relieving), memory, and affective (responsible for emotions) brain regions”.   The researchers felt that this enhancement of connections between various parts of the brain is probably responsible for the pain relief induced by acupuncture.   After the recent German study of acupuncture for headaches which involved over 15,000 patients there is little doubt that acupuncture works for headaches (and many other pain conditions), but this study helps provide stronger scientific evidence that the relief is not due to placebo.

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I’ve written in a previous post that people exposed to pleasant music feel less pain than people listening to unpleasant music or to no music at all.  Some studies have suggested that happy music (typically music with faster tempo and major mode) is better at relieving pain than sad music.  A study by Chinese researchers published earlier this year in the journal Pain showed that both sad and happy melodies lower pain perception in healthy volunteers, as long as the melodies are pleasant.  This study adds to the growing evidence that music can indeed relieve pain and, not surprisingly, that the music has to be pleasant.

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Botox appears to be effective for peripheral nerve pain according to a study by French researchers.  This finding is consistent with my observation that injecting Botox into the skin of the top of the head in patients with headaches relieves pain in that area.  When I started injecting botulinum toxin (Botox) for headaches about 15 years ago the assumption was that Botox works by relieving spasm of muscles in the forehead, temples, back of the head, and neck.  However, some patients would come back and report that their headache was gone in the injected areas, but not on the top of the head.  When gave additional injections the top of the head pain also stopped.  I also see patients who get Botox injections for their headaches from dermatologists or plastic surgeons and do not obtain adequate relief.  This is usually because only the front of the head is injected, rather then all areas of pain.   There have been other reports of Botox relieving pain of diabetic as well as trigeminal neuralgia, however the French group conducted a very rigorous double-blind study which provides scientific proof of pain-relieving properties of Botox.

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Red wine to relieve migraine?  Red wine is a well-known trigger of migraine headaches (although French tend to disagree).  A recent study published in journal Pain found that resveratrol, the active ingredient in red wine which is responsible for its health benefits, has pain relieving properties when given to rats.  There have been no reports in the literature or from my own patients that resveratrol causes headaches and judging from this study, it may in fact help.

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Progressive muscle relaxation is an integral part of biofeedback training, but can be used by itself for the treatment of migraine and tension-type headaches.   A group of researchers at the Ohio State University published an article in the journal Pain which reports the effect of progressive muscle relaxation on experimental pain in healthy volunteers.   A single 25-minute tape-recorded session of progressive muscle relaxation resulted in a higher pain tolerance and reduced stress from pain.  It can be safely assumed that regular practice sessions will result in even better results and all pain patients, including those with headaches should be encouraged to learn this simple technique.

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A person  empathizing with someone in pain perceives his or her own pain as more severe and unpleasant.  Researchers at McGill University published these findings in the current issue of journal Pain.  This observation could explain, at least in part, high frequency of pain symptoms observed in spouses of chronic pain patients.   Even laboratory mice have heightened pain behavior when exposed to cagemates, but not to strangers, in pain.  Clearly, the thing to do is not to ignore your spouse’s or friend’s pain, but rather try to get the pain relieved.  If that is not possible, hopefully, a cognitive-behavioral psychologist may be able to devise a way to be very supportive and helpful without constantly feeling badly for the person in pain.

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Facial expression of pain seems to make you feel worse, according to a study published in the May issue of The Journal of Pain.  Healthy volunteers were asked to make a painful expression before the pain started and without anyone appearing to be watching (to avoid “social feedback”).  The pain was perceived more unpleasant when the volunteers made a painful facial expression compared to when a neutral facial expression was made.  Practical application of this study is in that people in pain should try to avoid grimacing from pain and keep their faces relaxed.  The authors discuss recent brain imaging studies which seem to confirm an old observation that facial expression can cause one to experience emotion that is being expressed.  In other words, forcing yourself to smile may improve your mood, while making an angry  face can make you feel angry.

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German researchers showed that acupuncture relieves back pain significantly better than combination of medications, physical therapy and exercise.  They enrolled over one thousand patients with chronic back pain in a study that compared traditional Chinese acupuncture (where acupuncture sites selected based on pulse diagnosis and other traditional methods and needles are placed along specific meridians on the body) with sham acupuncture (needle are placed superficially and outside the traditional points) and conventional approach.  It turns out that 10-15 sessions of both traditional and sham acupuncture treatments were better than conventional treatment, providing relief in 47.6%, 44.2% and 27.4% of patients respectively.  This large study clearly proves the efficacy of acupuncture in back pain, regardless of the acupuncture technique. Similar results have been found in headache patients. 

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Botox relieves migraine headaches and other painful conditions, such as sciatica, neuralgias and neck pain.  A recent study of 43 patients with arthritis of the shoulder suggests that Botox may relieve arthritis pain as well.  This was a double-blind study where half of the patients were given Botox and the other half saline injections.  Neither the doctor nor the patient knew what was being injected.  The results clearly favored Botox and the difference was statistically significant.  This adds another possible indication to a long list of conditions that Botox might relieve.  The safety of Botox in this study was as remarkble as in all previous studies, which now number in hundreds.  

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We always recommend exercise as one of the most effective preventive treatments for migraines and tension-type headaches.  However, it appears that some patients may have difficult time exercising because of low vitamin D levels.  Vitamin D receptors are located within muscle and are important for normal muscle activity.  Michael Hooten and colleagues discovered that pain clinic patients who had low vitamin D levels had lower exercise tolerance as well as lower general health perception than patients with normal levels.  Most people are familiar with the role of vitamin D in bone health.  However, it has many other functions in the body.  In addition to exercise tolerance, another unexpected effect of vitamin D deficiency is to worsen symptoms of gastro-esophageal reflux, which causes heartburn and other symptoms.  Taking vitamin D supplements relieves reflux symptoms in some patients.  Many people are not taking sufficient amounts of vitamin D.  If deficiency is documented by a blood test, patients usually need to take 1000-2000 units a day.

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A recent study by Richard Harris presented at the American Pain Society’s meeting of 18 patients with fibromyalgia showed different brain mechanisms for true and sham acupuncture.  It appears that placebo response in sham acupuncture can be differntiated from the true acupuncture response by measuring binding properties of the mu opioid receptor in the brain.  This study further confirms the fact that one of the most important mechanisms of action of acupuncture is through the endogenous opioid system and that it is different from the mechanism of the placebo effect.

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