14 March 2006

Milimeter wave therapy

A Soviet technology developed during the Cold War to keep short-range military communications secure may someday provide relief from hard-to-treat conditions such as nerve pain, intense itching, and nausea caused by chemotherapy. And, with the support of a $4 million grant from the National Institutes of Health, Temple University School of Medicine scientists are the only group in the United States now investigating this alternative therapy.
Millimeter wave therapy, which directs a low-intensity electromagnetic beam to the skin, has been used for more than 25 years in Eastern Europe, where it is credited with alleviating more than 50 different conditions, ranging from heart disease to skin wounds and even cancer. Doctors there believe that the waves boost the immune system, act as an anti-inflammatory, and provide sedation and pain relief, all with virtually no side effects.

While the therapy remains largely unknown in the West, Marvin Ziskin, M.D., professor of radiology and medical physics at Temple, first encountered it in the early 1990s on a trip to the former Soviet Union.
"We found that millimeter waves reduce pain in laboratory animals, stimulate the immune system and slow the progression of skin melanomas, without damage to the skin or other harmful side effects. It's a painless, non-invasive, easily tolerated therapy," said Ziskin.
Eastern European doctors directly apply millimeter waves to skin lesions and acupuncture points. It's also common to beam them onto a diseased organ or a troublesome joint.

Absorbed very rapidly by the skin, millimeter waves appear to initiate a response in peripheral nerve endings. Ziskin's working hypothesis is that as waves reach these nerve endings, a signal is conveyed to the nervous system to modulate neural activity, in the process activating various biological effects. In one possible scenario, millimeter waves trigger the release of opioids that are known to be involved in sedation, pain relief and modulation of the immune system.

"Applying the waves to points on the skin with the highest density of nerves appears to work best. Using this approach, under strict double-blind conditions, we've produced evidence of pain relief in experimental animal models as well as in a small group of human volunteers," said Ziskin.

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Obese people more sensitive to pain?

COLUMBUS , Ohio – Obese people may be more sensitive to pain than people who aren't obese, a new study suggests.

All of the older adults who completed the study had osteoarthritis of the knee, a disease that causes inflammation and extreme pain in the knees.

Participants were given a mild electrical stimulation on their left ankle to measure their pain reflex. The stimulus was given before and after the participants took part in a 45-minute coping skills training session that included a progressive muscle relaxation exercise.

The obese patients showed a greater physical response to the electrical stimulation than did the non-obese people, both before and after the training session. This indicates they had a lower tolerance for the painful stimulation despite reporting, in questionnaires, that they felt no more pain than non-obese people.

"The relaxation procedure helped both groups cope with pain," said Charles Emery, the study's lead author and a professor of psychology at Ohio State University. "Additionally, our tests showed both groups had higher physical pain thresholds after the relaxation session. But the obese participants still had a lower threshold for tolerating the pain."

"This is important because if an obese person begins an exercise program, he may not cognitively experience pain when in fact it is hurting the body on some level," Emery said. "That could lead to severe pain down the road."
But they were particularly interested in seeing how the obese group responded to pain; according to Emery, a small number of studies have looked at pain sensitivity in obese people, but many of these studies report conflicting results.

"Some studies say that obese people are more tolerant of pain, while other studies say they are less tolerant," Emery said.

About a third of the study's 62 participants were obese. Researchers determined who was obese based on participants' body mass index (BMI) scores, which relates height to weight. Obese patients in this study had a BMI greater than 30 but less than 35. (Scores higher than 35 are considered morbidly obese.)

The participants underwent two rounds of electrical stimulation – once before, and once after a 45-minute training session where they learned different ways of coping with pain, including instruction in progressive muscle relaxation therapy.


Another acetaminophen warning

Wow. Acetaminophen overdose causes 40-50% of acute liver failure cases.

Medical News Today
Expert Warns Of Overuse Of Over-the-Counter Pain Medication
13 Mar 2006

Acetaminophen is generally a safe and effective medication, one that is used by millions of people every day to treat minor aches and pains and to diminish fevers. It might surprise many people, then, that overdoses of Tylenol and other products containing acetaminophen account for a staggering 40 percent to 50 percent of all acute liver failure cases each year in the United States.

Of those cases, nearly half are unintentional overdoses, a recent finding that many experts say is alarming. That's why people need to take extra care not to take even a little more of the medication than the recommended dose during any 24-hour period.

“My overall recommendation for people using Tylenol is that it is a safe drug,” says Robert J. Fontana, M.D., associate professor of internal medicine at the University of Michigan Medical School, member of the Gastroenterology Division and medical director of liver transplantation. “However, like most other things in life, too much of a good thing can be bad for you.”

For instance, an adult should not take more than eight Tylenol Extra Strength pills, which contains 500 milligrams per tablet, in a 24-hour period (i.e. the maximum daily dose is 4,000 milligrams per day). Exceeding that dosage, could lead to inadvertent liver or kidney damage in some people, Fontana says.

Fontana notes that damage occurs acutely rather than chronically - in other words, it isn't the dosage of the medicine a person takes over several weeks that is the problem, it is the daily dose that may lead to liver toxicity.

Here's how the problem occurs: Whenever you take a medication, your liver typically is involved with metabolizing, or eliminating, the drug from your system. When you take too much acetaminophen, you overwhelm your body's ability to eliminate the medication safely. High levels of the medication can build up in the blood, and that can damage liver cells that are trying to metabolize the drug, which can lead to liver injury, Fontana says.

A multicenter study that the U-M Health System recently participated in indicated that about half of acetaminophen overdoses that resulted in liver failure were unintentional, something the researchers refer to as “therapeutic misadventures.”

“What I mean by that is that individuals were taking acetaminophen for some type of medical problem - such as a headache, back pain or the flu - inadvertently took too much and subsequently developed liver failure,” Fontana says. “If you go to a drug store, as many as 150 products that consumers can buy without a prescription have acetaminophen in them.”

It doesn't take much for someone to consume a toxic dose of acetaminophen. For instance, consider someone who is taking an over-the-counter product that helps stop sneezing or coughing that contains 350 to 500 milligrams of acetaminophen per dose, with one or two doses every four hours. If that person also has a headache or muscle aches, he or she may take some acetaminophen and quickly go into the potentially toxic range.

In addition to the possible overuse of acetaminophen when taking non-prescription medications, another potential hazard occurs among people who take Tylenol or a similar medication in addition to a prescription pain reliever that also contains acetaminophen, such as Vicodin or Darvocet.

“We're particularly concerned that health care providers may not be aware of this, and when they prescribe these potent pain medicines, there needs to be greater education of our patients of the total dose it is safe for them to take,” Fontana says. “In addition, patients with severe or chronic pain may take increasing doses of prescription narcotics and not be aware that they contain 500 to 750 milligrams of acetaminophen in each tablet.”

This is a concern not only for adults, but also for children because there's been a shift toward using acetaminophen products for babies and children. “As parents,” Fontana says, “we need to be aware of this so that we avoid inadvertent toxicity in trying to treat our children at home when they have high fevers.”

Other factors can compound a person's likelihood of developing liver damage from overuse of acetaminophen. Information increasingly suggests that if you drink alcohol daily or on a chronic basis, that may predispose you to liver damage from acetaminophen, Fontana says. That may occur due to development of nutritional deficiencies or a reduction in the level of the detoxifying enzymes in your liver as a result of drinking, he notes.

The U-M Health System and other institutions are involved with ongoing studies of acute liver failure and drug-induced liver injury. In addition to exploring and identifying the causes and natural history of acute liver failure, researchers also are doing exploratory work on a potential genetic predisposition to acute liver failure.

A recent study also described a new blood test to help identify patients with acetaminophen liver toxicity so that treatment can be started rapidly. “This new blood test holds great promise for identifying patients early on prior to the development of life-threatening liver failure,” Fontana says.

Facts about acetaminophen and liver damage:

-- Before taking acetaminophen, experts recommend that you tell your doctor if you have ever had liver disease or if you drink alcohol daily or on a chronic basis.

-- One way to prevent acetaminophen-related liver toxicity is to carefully read the labels on all medications so you are aware of their acetaminophen content (both prescription and over-the-counter).

-- Acetaminophen is found in Tylenol-brand products, but it also is found in numerous other brand-name medications, including some varieties of Excedrin, FeverAll, Genapap, Percocet and more. It also is included in combination products, such as Midol Teen Menstrual Formula Caplets containing Acetaminophen and Pamabrom. Many prescription pain relievers also contain acetaminophen, such as Lorcet Plus, Darvocet and Vicodin.

-- In case of an overdose, call your local poison control center at 1-800-222-1222. If the victim is not breathing, call 911.

-- Remember to keep medications locked up or out of reach of children.

-- Do not take the full day's dose of acetaminophen at one time; space it out over the course of the day.

Written by Katie Gazella



Another entry in my occasional series: Meet your analgesics (and anesthetics in this case)


What it is:
First synthesized in Belgium in the late 1950s, fentanyl, with an analgesic potency of about 80 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic under the trade name of Sublimaze®. Thereafter; two other fentanyl analogues were introduced; alfentanil (Alfenta®), an ultra-short (5-10 minutes) acting analgesic, and sufentanil (Sufenta®), an exceptionally potent analgesic (5 to 10 times more potent than fentanyl) for use in heart surgery. Today, fentanyls are extensively used for anesthesia and analgesia. Duragesic®, for example, is a fentanyl transdermal patch used in chronic pain management, and Actiq® is a solid formulation of fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption. Actiq® is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. Carfentanil (Wildnil®) is an analogue of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice to immobilize certain large animals. Link

Wikipedia entry

Its use in chemical warfare:
Center for Nonproliferation Studies
The Moscow Theatre Seige

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13 March 2006

06 March 2006


In case you've been riveted to your seats these past few months, waiting to see if I get a job, the search is over.

Come this summer, PFP's world headquarters will be moving back to the City of Angels after experiencing 7-years of actual winter. I've been hired by Cal State University Northridge's philosophy department

I'm extremely happy since this was the job I really wanted. And when this blogger is happy, you all get more (about) pain.

Now, back to the pain and suffering.

Primer on pain

Just came across this online primer on pain physiology and psychology. I didn't get a chance to read the whole thing and so I can't vouch for it, but it seems pretty accessable and non-technical.


05 March 2006

Solicitiousness and pain, or: your blogger tries some research

Another favorite topic:
Solicitousness and chronic pain: a critical review
Toby RO Newton-John
Abstract: This article offers a critical review of the literature examining spouse responses to the pain behaviour of
chronic pain patients. An overview is given of 27 studies that have explored patient–spouse interactions
in chronic pain, together with a summary of the various .ndings. It is concluded that the body of research
is broadly supportive of the operant behavioural paradigm on which it has developed. Patients’ coping
with chronic pain is signi.cantly influenced by the ways in which those closest to them respond to their
expressions of discomfort. However, it is argued that the behavioural model alone is insuf.cient when
accounting for the complexity of pain couples’ interactions. The impact of the spouse’s response is mediated
by a range of cognitive and affective variables that have yet to be fully recognized in the research
literature. It is also argued that the operationalization of the construct of solicitousness, which is central
to research on chronic pain couples, is flawed. A number of suggestions for future theoretical and empirical
developments in this area are made.
Pain Reviews 2002; 9; 7-27

Being the dedicated scholar I am, I recently decided to see if solicitiousness had a similar effect in the short-term by breaking my ribs. Unfotunately, I've been a bit too dedicated to my research in the past. My wife has had to sit through too much blabber about solicitiousnes and pain, and therefore knows better than to pay attention to every whine.. So while I get plenty of sympathy, I still have to fetch my own Advil.

And I'm better-off for it.



A nice resource of work on that perennial favorite of philosophers everywhere: congenital insensitivity to pain and anhidrosis (CIPA):

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