by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator
A recent study published by The Lancet (to read the study abstract, click here ) explores the question of efficacy and safety of corticosteroid injections for tendinopathy, both short-term and long-term. Using a systematic review of randomized control studies, researchers observed that corticosteroid injections reduced pain in the short term compared with other interventions, but this effect was reversed at intermediate and long terms.
As this research indicates, there is a need for multidisciplinary pain management approaches in the treatment of chronic pain conditions. What have been your experiences with using corticosteroid injections?
Tagged: Chronic Pain, MS-PREP, Pain, Pain Management, Pain Research, PREP, PREP-AIRED, the Lancet November 2, 2010
Thank you to our guest blogger, Dan Fields, for this informative and timely book review of Dissolving Pain: Simple Brain-Training Exercises for Overcoming Pain by Fehmi and Robbins.
Can changing how you pay attention help to ease pain? Yes, suggest psychologist and biofeedback expert Les Fehmi, PhD, and science writer Jim Robbins in their new book, Dissolving Pain: Simple Brain-Training Exercises for Overcoming Chronic Pain (Trumpeter, 2010). The conventional understanding of pain is that it results from an injury to the body—such as a slipped disk, in the case of back pain. However, the authors contend that “pain, whatever its causes, resides principally in the brain and can therefore be treated by working with the mind in specific ways.”
Consider the phenomenon of phantom limb pain, in which pain persists in a limb after it has been removed. “Areas of the brain associated with the missing limb can still, mistakenly, generate pain, probably because they are [abnormally] sensitized,” according to Fehmi and Robbins.
You can reduce the intensity of any type of pain, the authors suggest, by expanding your focus of attention—like zooming out with a camera. “When you are narrow-focused on something, including pain, it represents 100 percent of your awareness. When you broaden your attention beyond the pain, the pain becomes a fraction of your total awareness,” they write.
And the quickest way to expand your focus is “to become aware of space,” say Fehmi and Robbins. The book and an accompanying CD include guided exercises that ask if you can imagine the distance between various parts of the body. These exercises supposedly encourage the brain “to produce more of the slower, more rhythmic brainwave frequencies associated with healing, balance, and well-being,” they write.
In contrast, a narrow focus of attention “increases the frequency of our EEG, tenses muscles, and generally makes us more sensitive to pain,” claim the authors.
The book includes many anecdotes of how the attention exercises have helped Fehmi’s patients with back, joint, or other types of pain. However, this reviewer is not aware of any solid research on this mind-body approach. So it’s up to readers to try the exercises for themselves and see if they help.
Dan Fields is a freelance health writer and former editor in chief of Dr. Andrew Weil’s Self Healing newsletter. He lives in the Boston area, and his email address is dfields820@gmail.com
Tagged: biofeedback, Brain, Chronic Pain, Pain, Pain Management October 10, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Researchers and clinicians are coming to the realization that there is a gender difference in how pain is experienced between men and women. While males and females seem to have comparable patterns of pain in childhood, at puberty certain types of pain become more common in females. And females report a higher pain severity as compared to males after puberty. Some research suggests that one explanation may be that estrogen protects against pain at high levels and enhances or amplifies pain at low levels, consistent with menstrual cycles. However, gender based pain research is in its very early stages, one obstacle being that most basic pain research has been done only on male mice and rats. Researchers are now beginning to understand that, in fact, males and females may process pain very differently due to hormonal and other factors. Dr. Daniel Carr, founder of the Tufts University School of Medicine’s Pain Research, Education and Policy Program and an internally recognized expert in pain management recently stated in a Boston Globe article, “The conditions that cause pain affect men and women differently in terms of prevalence and severity.” Carr noted that some drugs affect men and women differently, as well as the social and cultural dimension of gender which may modify treatment choices. “Whatever pain therapy one selects should have some flexibility to it”, added Dr. Carr.
To read the Boston Globe article The Gender Gap: Learning Why Men and Women Experience Pain Differently, click here
September 27, 2010
by Nancy Mitchell, MS-PREP
A prescription for music may be a beneficial adjunct to more traditional therapies according to research at Glasgow Caledonian University. Check out this article in Science Daily.
Tagged: Glasgow Caledonian University, MS-PREP, music, Pain, prescription September 21, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
August 11, 2010 marked the culmination of intensive research and planning for two candidates for Master’s degrees in the Pain Research, Education and Policy Program at the Tufts University School of Medicine with the presentation of their capstone projects.
Margaretta Elizabeth (Beth) Sangree, a student in the joint program with the New England School of Acupuncture (NESA), presented her capstone project entitled
Pictured L-R: Ylisabyth (Libby) Bradshaw, DO, MS, Associate Director of the Pain Research, Education and Policy Program; Margaretta Elizabeth (Beth) Sangree, MS-PREP candidate, Richard Glickman-Simon, MD, Director of the Pain Research, Education and Policy Program; and Sherry Brink, RN, BSN, MS-PREP candidate
“Measures of the Patient-Provider Relationship in Acupuncture Treatments”. Beth highlighted several studies that support the importance of relationship-centered care in effective pain treatment. Future directions will include quanitfiable, replicable, randominzed control studies to continue to document the effect of patient-provider relationship on treatment effectiveness.
Sherry Brink, RN, BSN, presented her capstone project on “Post-Op Pain Management in the Pediatric Patient” with emphasis on bringing best practices of post-op pain managment to underserved, international patient populations. Sherry recounted her experience bringing comprehensive pain management methods to a small rural hospital in the Andes mountains of Peru and her development and integration of a bilingual nursing education module on pain management currently being used by the staff in Peru. Sherry hopes to use her MS-PREP degree to further her international medical mission work by continuing to educate nurses worldwide in effective, compassionate pain management methods.
Congratulations to these two exceptional MS-PREP degree candidates!
Tagged: Education and Policy, MS-PREP, NESA, New England School of Acupuncture, Nursing, Pain, Pain Research, Pediatric, Peru, Tufts, Tufts University School of Medicine August 23, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
The NIH National Center for Complementary and Alternative Medicine Center’s Integrative Medicine Research Lecture Series provides overviews of the current state of research and practice involving complementary and alternative medicine practices and approaches, and explores perspectives on the emerging discipline of integrative medicine. The upcoming lecture on August 9, 2010 may be of specific interest for those interested in learning more about clinical trials on acupuncture in Germany and pain management.
Lectures are open to the public at the NIH Clinical Research Center in Bethesda, Maryland (10:00 AM EDT) or now by free videocast at videocast.nih.gov
Upcoming LectureDate: August 9, 2010
Speaker: Claudia Witt, M.D., Professor for Complementary Medicine and Vice Director at the Institute for Social Medicine, Epidemiology and Health Economics Charite University Medical Center in Berlin, Germany
Topic: The acupuncture trials from Germany: What do they tell us about efficacy, effectiveness, cost-effectiveness, and safety?
Location: NIH Campus, Building 31, 6C, Room 6
Tagged: acupunturemGermany, Integrative Medicine, NIH, Pain, PREP, Tufts University August 4, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP graduate student and PREP-AIRED blog moderator
With an estimated 17 percent of U.S. miliary personnel returning from Iraq and Afghanistan with symptoms of PTSD or Post Traumatic Stress Disorder (Archives of General Psychiatry), the military is now leading the way in integration of western and eastern models of care into the healthcare system. Use of acupuncture, meditation, yoga, and tai chi are currently being utilized in conjuntion with allopathic medical and psychological care. A recent article in Statesman.com highlights these integrative efforts.
Click here to read the article.
Tagged: acupunture, meditation, military, Pain Policy, post traumatic stress disorder, PREP, PTSD, Tufts June 24, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thanks to MS-PREP alumna, Xu Cheng, for sending along a link to a recent issue of Nature Neuroscience which highlights a study on acupuncture’s pain reducing effect. In animal studies, the neuromodulator adenosine appears to play a significant role in the local anti-nociceptive properties of acupuncture. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture Click here to read the abstract of the study
Tagged: Acupuncture, Adenosine, Nature, Neuroscience, PREP, Tufts University School of Medicine, Xu Cheng June 2, 2010
By Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student and PREP-AIRED blog moderator
Thank you to 2010 MS-PREP alumna, Nancy Mitchell, for sending along a recent update to the Cochrane Library and the Cochrane Database of Systemic Reviews addressing acupuncture and tension-type headaches. In a previous Cochrane Review (2001), acupuncture was found to be inconclusive as a treatment for tension-type headaches. However an updated 2009 Cochrane Review on acupuncture and tension-type headaches, which included 11 randomly controlled trials, concluded that acupuncture may be a valuable treatment option for patients suffering from frequent tension-type headaches.
The Cochrane Review stated: “We reviewed 11 trials which investigated whether acupuncture is effective in the prophylaxis of tension-type headache. Two large trials investigating whether adding acupuncture to basic care (which usually involves only treating unbearable pain with pain killers) found that those patients who received acupuncture had fewer headaches. Forty-seven percent of patients receiving acupuncture reported a decrease in the number of headache days by at least 50%, compared to 16% of patients in the control groups. Six trials compared true acupuncture with inadequate or ‘fake’ acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. Overall, these trials found slightly better effects in the patients receiving the true acupuncture intervention. Fifty percent of patients receiving true acupuncture reported a decrease of the number of headache days by at least 50%, compared to 41% of patients in the groups receiving inadequate or ‘fake’ acupuncture. Three of the four trials in which acupuncture was compared to physiotherapy, massage or relaxation had important methodological shortcomings. Their findings are difficult to interpret, but collectively suggest slightly better results for some outcomes with the latter therapies. In conclusion, the available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.”
Cochrane Reviews are an integral part of evidence based medicine. It is important to include both allopathic and integrative medicine studies in the rigorous review process to further our knowledge of effective strategies to treat and manage chronic pain conditions.
Tagged: Acupuncture, Chronic Pain, Cochrane Reviews, Education, headache, MS-PREP, Nancy Mitchell, Pain Policy, Research, Tufts, Tufts University School of Medicine May 23, 2010
by Pamela Katz Ressler, RN, BSN, HN-BC, MS-PREP student, PREP-AIRED blog moderator
Thanks to Cyndie Rodman, MS-PREP ’09, for sending along the press release from the recent Massachusetts Pain Initiative Survey. Cyndie writes that “the survey not only quantified the incidence of chronic pain among the Massachusetts general population, but also the differences and disparities experienced by minorities versus non-minorities. This is the first Massachusetts study we are aware of to look at how pain is experienced by minorities compared to non-minorities.” Tufts University School of Medicine’s Pain Research, Education and Policy (PREP) faculty member, Carol Curtiss, RN, MSN, as well as PREP guest lecturer, Paul Arnstein, PhD, APRN-BC, played instrumental roles in the survey. Click here to read the Massachusetts Pain Initiative’s press release about the survey. For more information about the Massachusetts Pain Initative, click here.
Tagged: Carol Curtiss, Chronic Pain, MA PI, Massachusetts Pain Initative, Paul Arnstein, PREP, Tufts, Tufts University School of Medicine May 10, 2010
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