Being Hungry Turns Off Perception of Chronic Pain

Interesting....

https://goo.gl/Ju7PEU

Pain can be valuable. Without it, we might let our hand linger on a hot stove, for example. But longer-lasting pain, such as the inflammatory pain that can arise after injury, can be debilitating and costly, preventing us from completing important tasks. In natural settings, the lethargy triggered by such pain could even hinder survival.

According to research by University of Pennsylvania neuroscientists, the brain has a way to suppress chronic pain when an animal is hungry, allowing it to go look for food while leaving intact the response to acute pain. Their work pinpointed a tiny population of 300 brain cells responsible for the ability to prioritize hunger over chronic pain, a group of neurons that may offer targets for novel pain therapies.

“In neuroscience we’re very good about studying one behavior at a time,” says J. Nicholas Betley, an assistant professor of biology in Penn’s School of Arts and Sciences. “My lab studies hunger, and we can find neurons that make you hungry and manipulate those neurons and monitor their activity. But in the real world, things aren’t that simple. You’re not in an isolated situation where you’re only hungry. This research was to try to understand how an animal integrates multiple needs to come to a behavioral conclusion that is optimal.”

“We didn’t set out having this expectation that hunger would influence pain sensation so significantly,” says Alhadeff, “but when we saw these behaviors unfold before us, it made sense. If you’re an animal, it doesn’t matter if you have an injury, you need to be able to overcome that in order to go find the nutrients you need to survive.”

The Hard Truth About Back Pain: Don’t Rely on Drugs, Scans or Quick Fixes

https://goo.gl/7EdzRG

Most treatment is wasteful, wanton and wrong, says the Lancet. The key is to try to keep walking and working.

The good news is that if your backache is musculoskeletal — and it usually is — 90% of cases will be better within six weeks. And that is irrespective of what you do. There’s no good evidence that interventions, ranging from Tens machines (which use a mild electric current), acupuncture, physio, osteopathy and chiropractic to epidural injections and surgery, significantly effect the outcome. Prolonged bed rest — still advocated in some countries — is positively dangerous, as it can cause blood clotting (thrombosis) and makes recovery from back pain less likely.

It’s tempting to want a scan or special investigations if you develop back pain. But scans don’t correlate well with symptoms; you can have a dire-looking scan with no symptoms or a fairly normal-looking one with dreadful pain. A scan is useful for surgeons if you need an operation, and other imaging is important if an underlying fracture is suspected. If your back pain is associated with an underlying inflammatory condition like Crohn’s, ulcerative colitis or psoriasis, you will need investigation and referral to a rheumatologist.

The key to recovery is to try to keep walking and working. Different approaches help different people; it’s good to find the least risky option that suits you. My own favourite is a Tens machine: the evidence may not be great, but it’s cheap, safe, and happens to work for me.

Painkillers can be useful in the short term, if that’s the only way you can keep moving.

NAVIGATING AND/OR AVOIDING THE INPATIENT MENTAL HEALTH SYSTEM

Long and thorough description of how voluntary and involuntary treatment works in the real world...

https://goo.gl/MMEYTa 

This is in response to questions I get about how to interact (or not interact) with the inpatient mental health system and involuntary commitment. The table of contents is:

1. How can I get outpatient mental health care without much risk of being involuntarily committed to a hospital?
2: How can I get mental health care at a hospital ER without much risk of being involuntarily committed?
3. I would like to get voluntarily committed to a hospital. How can I do that?
4. I am seeking inpatient treatment. How can I make sure that everyone knows I am there voluntarily, and that I don’t get shifted to involuntary status?
5. How can I decide which psychiatric hospital to go to?
6. I am in a psychiatric hospital. How can I make this experience as comfortable as possible?
7. I am in a psychiatric hospital and not happy about it and I want to get out as quickly as possible. What should I do?
8. I am in the psychiatric hospital and I think I am being mistreated. What can I do?
9. I think my friend/family member is in the psychiatric hospital, but nobody will tell me anything.
10. My friend/family member is in the psychiatric hospital and wants to get out as quickly as possible. How can I help them?
11. How will I pay for all of this?
12. I have a friend/family member who really needs psychiatric treatment, but refuses to get it. What can I do?

I am a psychiatrist, which both means I have some useful experience here, and makes it hard for people trying to avoid the system to trust me. Anything written with too much honesty risks degenerating into “here’s how to cheat the system so nobody will know you’re about to commit suicide”. But anything written with too little honesty risks degenerating into some variation of “trust the wise benevolent doctors to do what is best for you”. This is an impossible edge to balance on, and I am sure I fail at one point or another.

Chronic Pain Patients Need — And Want — Non-Opioid Options

https://goo.gl/bVygPZ

Approximately 11.5 million U.S. adults misused prescription painkillers in the past year ― and for more than half of them, the reason for the misuse was physical pain.  

We hear a lot about opioid-related deaths and overdoses in the news, but we rarely talk about the underlying issues that lead so many to look for any and all options available. Many opioid users suffer from chronic illness and are prescribed opioids because other treatments grant them no relief.

Attorney General Jeff Sessions recently said that chronic pain sufferers should “take some aspirin … and tough it out.” Unfortunately, his insensitivity and ignorance surrounding chronic pain is not unique. Chronic pain is a complex condition and, in many cases, is unsolvable, longstanding and misunderstood.  

Like nearly 100 million other U.S. adults, I too suffer from chronic pain. I have systemic lupus and advanced osteoarthritis, and the combination of these two diseases means I live with almost daily aches and pains, ranging from minor to extreme, and from slight achiness to total immobility.

I know how difficult it is to live a full, rich life while experiencing unending throbbing, stabbing and burning. I’ve also learned to work around my limitations and ignore my pride. I use a wheelchair in the airport when I need it. I “chair dance” at parties when my spirit is willing but my body is weak. But I worry about the social events with too few chairs, about the happy hours, the fundraisers and the buildings without elevators. I’ve even had cab drivers reprimand me for hailing a ride to the train station only a few blocks away.

No one can say they are forever immune to chronic pain; it eventually affects many of us after surgery, after injury, after illness or simply as we age. And all Americans pay the price; according to a 2011 report from the Institute of Medicine, chronic pain costs the nation an estimated $565 billion to $635 billion in treatment costs and lost productivity.

Few good treatment options exist for chronic pain patients ― believe me, I’ve tried my share. Knee braces. Canes. Anti-inflammatories. Steroids. Aqua therapy. Physical therapy. Acupuncture. Infusions and shots in my knees. (Yes, in my knees.) Once a skeptic of alternative therapies, I even went vegan, slopped on some arnica and capsaicin cream, digested turmeric and completed a Mindfulness Based Stress Reduction class. Twice. Many of these alternative treatments are prohibitively costly and not covered by insurance, limiting services for the uninsured or those who are on a fixed or limited income.

However, I’m considered one of the lucky ones. I live in a college town with a nationally recognized university hospital and a wonderful and humane team of doctors who are attentive to my concerns and respected in their fields. I have good health insurance and am able to attend my appointments. I respect and heed my doctors’ recommendations and take my medications as prescribed.

Last Tuesday, the Journal of the American Medical Association released a much-anticipated study that compared opioid and non-opioid medications for patients with moderate to severe chronic pain. The randomized clinical trial followed 240 patients over 12 months and found that opioids were not as effective as non-opioid medications in treating back pain and osteoarthritis in the knee and hip.


The harm of “use it or lose it” in managing fibromyalgia pain

https://goo.gl/r3mjSe 

[TW this post contains descriptions of my own experiences with pain and common negative interactions with medical providers that may be triggering to those with medical trauma. Also includes discussions of “curative” diets, disordered eating, and anti-fat bias in medicine.]

[Note that I also talk about relief I’ve intermittently experienced from chronic pain after 10+ years of dealing with it unrelentingly, largely due to enough privilege to access the kind of medical specialists who don’t take insurance and the privilege to be able to access/read medical research. Every person is unique and none of this is medical advice, because any improvements I have are largely due to privilege like “having someone believe me enough in order to actually operate and remove the organ causing a lot of pain.” If you send this to a friend with chronic pain as an example that other people can experience relief from pain intermittently and they should too MAYBE DON’T DO THAT and reconsider your life choices. Every person is unique, accessing medical care is a tangling thicket of bureaucracy and expense, and what works for my body isn’t going to work for everyone else’s.]

When I was first diagnosed with fibromyalgia, my mother’s rheumatologist barely looked up from the lab results. “There’s not much we can do for you,” she said. “There’s no treatment or cure. Your best bet is to exercise and lose weight.”

I want to talk concretely about the effects of what the common medical advice for fibromyalgia is: namely, to “use it or lose it” regarding exercise; to lose weight; that the cause of one’s pain is most likely some sort of “sensitization” to pain possibly caused by trauma. Whether or not one’s patient has fibromyalgia, I believe this medical advice is potentially harmful. It was to me.

The “use it or lose” it medical advice would become a litany I would hear from rheumatologists on the occasions that I would go because my GP insisted that yes, rheumatologists really did manage fibromyalgia patients like me.

Meanwhile I delved for some kind of solutions or at least practical ways to address pain. I had some luck with physiatry (or functional rehabilitation specialists), because even when no one knew the exact why of my pain they could at least give me concrete tips on how to manage it. It was a physiatrist who taught me that Thermacare wraps exist: heat packs that stay warm for 8 hours and can be worn under clothing! It was a physiatrist who taught me how to make a homemade massager for my numerous muscle knots out of a racket ball and a sock, which is my current go-to for the knots of pain that live beneath my scapula.

Understanding Addiction and Dual Diagnosis

https://goo.gl/pMFSHj

Reports published in the Journal of the American Medical Association tell us that about 50 percentof people with severe mental disorders are affected by substance abuse and roughly 37 percent of alcohol abusers, and 53 percent of drug abusers, also have at least one serious mental illness.

This dual diagnosis is a problem that clearly goes both ways. But science has a long way to go before we can truly understand why a dual diagnosis of mental illness and addiction is so common.

People with major psychiatric disorders, including schizophrenia, bipolar and unipolar depression, post-traumatic stress disorder, borderline and antisocial personality disorders are much more likely to have a Substance Use Disorder (SUD) than the general population.

Alone, this information suggests that psychiatric disorders may predispose you to developing a substance use disorder. But is truly the case?

Another popular theory is that people with mental illnesses are self-medicating when they abuse substances.

Theory of self-medication

There are obvious reasons why someone with a mental health disorder may choose to self-medicate. Many street drugs work in a way that’s similar to, or the same way as the prescription drugs that are used to treat various disorders. For people who have limited access to healthcare, street drugs are much easier to get.

Here are some examples of how street drugs may initially seem to treat symptoms of a mental health disorder.

Ep 20: Asian American Women and Mental Health

https://goo.gl/7j3RjY

Today’s episode is about Asian American women and mental health with guests Emily Wu Truong and Jessica Gimeno. You’ll hear Emily and Jessica talk about their personal stories, experiences within Asian American communities, and their mental health advocacy. 

Content note: Please be aware that there will be discussions of suicide and suicide attempts. For help call the National Suicide Prevention Hotline at 1-800-273-8255, they offer services in 150 languages and there is a chat option.  

Transcript

[Google doc]     [PDF]


Trauma-informed reader response to the ill-informed article, “Publicly We Say #MeToo. Privately We Have Misgivings.”

https://goo.gl/XLN6rD

I have wanted to write about the missing voices from the “me too” movement for a while now, but have not due to a host of reasons (lack of time, insecurity about my writing, fear of people’s responses, etc.) However, The New York Times Magazine contributing writer, Daphne Merkin, has expressed an opinion that likely is held by many, and it’s an opinion that I believe should not go without being appropriately challenged (read the article here: https://www.nytimes.com/2018/01/05/opinion/golden-globes-metoo.html). Aside from Merkins’ self-proclaimed sample size lacking all diversity aside from age, “The women I know — of all ages”, Merkin seems to lack any sort of a trauma informed opinion, which is an incredibly dangerous and ignorant thing to do when discussing such a traumatic topic. My intention for the rest of my response is to illustrate two things:

1. The host of female voices that are inherently missed in an internet-based movement.

2. The incredible necessity of understanding the neuroscience of trauma and abuse when discussing sexual assault, abuse and harassment.


Alcoholics Anonymous works for some people. A new study suggests the alternatives do too.

https://goo.gl/4m2zYM

For the past several decades, Alcoholics Anonymous and the 12 steps have dominated addiction treatment in America — boasting millions of adherents and turning into the standard option within most addiction treatment programs in the US.

A new study has found, however, that AA, the original 12-step program, and others like it don’t have to be the only answer for people seeking out mutual help groups to deal with alcohol addiction.

The study, in short, looked at how people’s self-reported outcomes with AA and 12-step programs compare with the three biggest alternative mutual help groups — Women for Sobriety, SMART Recovery, and LifeRing. It concluded that these other groups perform about as well as 12-step programs.

“This study suggests that these alternatives really are viable options for people who are looking for recovery support and don’t like AA for whatever reason,” Sarah Zemore, lead author of the study, told me.