Tag Archives: joint pain

Managing Chronic Pain 10 Steps

Posted on by
Reply

Making the journey from patient to person takes time. The isolation and fear that can overwhelm a person with chronic pain grows over time. And the return to a fuller, more rewarding life also takes time.

It’s a journey with many phases. The ACPA describes these phases as Ten Steps.

The ACPA’s Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor’s advice and ask what you can do to move from a passive role into one of partnership in your own health care.
Continue reading →

Post to Twitter Tweet This Post

Insecure Teens Feel More Pain, Are More Likely to Be Anxious

Posted on by
Reply

December 8, 2009 — Insecure adolescents feel more intense pain and are more likely to be anxious and depressed than their secure counterparts, new research suggests.

The results of a large survey study suggest that interventions, such as cognitive behavioral therapy (CBT), that target certain attachment styles might be beneficial in teens.

“We might need to start to look at interpersonal factors like attachment styles if we want to create lasting changes in our interventions,” study author Michael J. L. Sullivan, PhD, McGill University, Montreal, Quebec, Canada, told Medscape Psychiatry.



The study was published online October 23 in the Journal of Pain.

For the study, researchers analyzed questionnaire responses from 382 high school students (223 female and 159 male). Participants were in grades 8 to 12 and had a mean age of 14.4 years.

To determine frequency and intensity of pain symptoms, researchers asked students how many times they had experienced 10 of the most frequent types of pain during the last 10 months and to rate the pain severity on an 11-point scale.

Researchers used another questionnaire to assess pain “catastrophizing” or the tendency to see symptoms as threatening or stressful. Students indicated the frequency with which they experienced each of 13 pain-related thoughts or feelings on a 5-point scale. The scale measures rumination, magnification, and helplessness.

Investigators also used the 18-item Adolescent Relationship Scale Questionnaire to assess attachment styles of students.

These styles included:

• Secure (finding it easy to get emotionally close to others);

• Preoccupied (wanting to be completely emotionally close with others);

• Fearful (worrying about being hurt if too close to others); and

• Dismissing (finding it very important to feel independent).

Students also completed questionnaires to measure the severity of symptoms of anxiety and depression.

Girls Feel More Pain

Girls in the study reported greater pain severity, pain catastrophizing, and depression than boys and had higher scores on the rumination, magnification, and helplessness subscales. Boys scored higher than girls on dismissing attachment style.

The study found various relationships between attachment styles and anxiety, depression, and pain. A secure attachment style was associated with low levels of pain catastrophizing, anxiety, pain severity, and depression, whereas preoccupied and fearful attachment styles were associated with heightened pain catastrophizing, anxiety, pain severity, and depression.

“When you start to interpret your symptoms in a more alarmist or threatening fashion, there’s a whole cascade of negative psychological and physiological events that can occur,” said Dr. Sullivan.

“If you’re experiencing pain, the more you attend to it the more you’re actually going to be experiencing more intense pain and the more you’re going to be focusing on the negative aspects of your symptoms. Over time, that might also have a wearing effect on your mood, leading to increases in anxiety and depression.”

Results Helpful

Although it is probably expected that a secure attachment is linked to lower levels of anxiety and depression, the finding that this attachment style is related to pain severity was surprising, said Katie Cullen, MD, assistant professor of psychiatry, University of Minnesota Medical School, Minneapolis. “We wouldn’t necessarily have known what to expect with the pain, so that was really helpful,” she said.

Dr. Cullen, who was not involved in the study, runs a depression clinic, whereas her colleague, Gail A. Bernstein, MD, professor and head, Program in Child and Adolescent Anxiety and Mood Disorders, University of Minnesota Medical School, runs an anxiety clinic. Young people often present to both clinics with pain symptoms.

Insecure adolescents experience more intense pain in the form of frequent headaches, abdominal pain, and joint pain. About 20% to 25% of adolescents experience recurrent or chronic pain, according to background information in the study.

Dr. Cullen said this statistic is potentially useful in raising awareness among specialists treating teens.

In discussing the physiological mechanisms by which catastrophic thinking might influence pain severity, the study authors note that high catastrophizing has been linked to lower pain threshold and lower pain tolerance. Those with high catastrophizing show enhanced activity in brain regions involved in anticipating and attention toward pain.

Move Beyond Current CBT Model

In this study, anxiety also tended to mediate the relationship between attachment styles and both pain severity and depression. These findings suggest that anxiety, pain catastrophizing, and attachment styles are related processes that make independent contributions to the prediction of pain severity and depression.

Although the study looked at attachment styles of teenagers, these styles typically begin in infancy. “There are still a lot of holes in our knowledge in this area, but there are some fairly strong indications that the style of attachment that you develop with your parents early on is something that follows you through the rest of your life,” said Dr. Sullivan.

The study results could affect the type of interventions used to treat teens. Current cognitive behavioral interventions focus on altering catastrophic thinking but not on attachment styles that drive that thinking. Often, the positive results from such therapy do not last, said Dr. Sullivan. “This suggests that while catastrophizing is definitely one of the factors contributing to negative outcomes, it might not be the ultimate source.”

He added that it is important to “move beyond” current CBT models that might be overly simplistic. “I would strongly suspect that over the next decade, we will start to see a lot more research looking at how different interpersonal processes impact on health outcomes.”

Dr. Bernstein said she found the results “intriguing and interesting” and the sample size “impressive.” “They have a big enough sample to be drawing some conclusions, and I think it’s something that will perhaps lead to further exploration in this area.”

The authors have disclosed no relevant financial relationships.

Journal of Pain. Published online October 23, 2009.

Post to Twitter Tweet This Post

Gender Difference In Severity Of Rheumatoid Arthritis

Posted on by
Reply

Women appear to suffer more from rheumatoid arthritis (RA) than men. This is revealed in research published in BioMed Central’s open access journal Arthritis Research and Therapy.

Tuulikki Sokka from the Jyvaskyla Central Hospital, Finland, along with other members of the Quantitative Standard Monitoring of Patients with RA (QUEST-RA) program, explored possible associations between gender and disease activity measures, treatments, and clinical characteristics in more than 6,000 RA patients from 70 sites in 25 countries. She said, “The possible influence of gender and gender-related variables on the symptoms, severity, and prognosis of rheumatoid arthritis has been of considerable interest for some time. Generally, women report more severe symptoms, greater disability, and often have higher work disability rates than men.”


The demographic characteristics of the group the authors studied were typical of an RA cohort; 79% were female, more than 90% were Caucasians and the mean age was 57 years. The patients were evaluated by a doctor and completed a self-report about their own condition. Women had higher scores (indicating poorer status) than men in all of the key measures, the gender gap being widest in the self-reported measures. According to Sokka, “Obvious differences between genders exist in the prevalence, age at onset, and level of production of harmful arthritis autoantibodies. Furthermore, women report more symptoms and poor scores on most questionnaires, including scores for pain, depression, and other health-related items”.

However, the authors do speculate that most of gender differences may originate from the measures of disease activity rather than from the RA disease activity itself. Sokka said, “Women have less strength than men, which has as much of a major effect in the functional status of patients with RA as it does in the healthy population. In fact, the gender differences in musculoskeletal performance remain even among the fittest individuals – female and male athletes still compete separately. Given that woman is the “weaker vessel” concerning musculoskeletal size and strength and her baseline values are lower than men’s, the same burden of a musculoskeletal disease may appear to be more harmful to a woman than to a man.”

Post to Twitter Tweet This Post

Appetite Hormone May Play a Role in the Development of Osteoarthritis

Posted on by
1

New research suggests that the appetite-regulating hormone leptin may play a role in the long-recognized connection between obesity and osteoarthritis (OA). The most common form of arthritis, osteoarthritis is characterized by the breakdown and loss of cartilage and the formation of bony overgrowths in the joints.

Scientists have long known that obesity is the number one preventable risk factor for osteoarthritis, but only in recent years have they ramped up research to understand how obesity and OA are connected.

Traditionally, the connection was assumed to be related to wear and tear. More weight meant a greater load for the joints to bear. But the wear-and-tear theory did not explain why joints in the hand, which do not bear weight, are also affected by OA. To better understand the systemic role obesity might play, Farshid Guilak, Ph.D., director of orthopaedic research in the Department of Surgery at Duke University, and his colleagues studied obese mice.

In their new study, supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and published in the journal Arthritis & Rheumatism, the group studied mice genetically engineered to lack either leptin or leptin receptors on the cells.

Leptin acts in the brain to control appetite, but to do so it must bind to receptors on cells. Removing either the molecule or the receptor has virtually the same effect — no functioning leptin. And for the mice studied, the result of no functioning leptin was a body weight approximately four times that of normal mice — which would seem like the ideal model for studying obesity-related OA. But, the mice didn’t develop OA at all. In fact, their joint cartilage was just as healthy, if not more so, than that of normal mice.

Researchers say if they can better understand the molecular mechanisms involved in OA, they may be better able to interfere with them and perhaps prevent the disease or stop its progression.

The Arthritis Foundation also provided funding for this study.

The mission of the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), a part of the U.S. Department of Health and Human Services’ National Institutes of Health, is to support research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases, the training of basic and clinical scientists to carry out this research, and the dissemination of information on research progress in these diseases. For more information about NIAMS, call the information clearinghouse at (301) 495-4484 or (877) 22-NIAMS (free call) or visit the NIAMS Web site at http://www.niams.nih.gov

Post to Twitter Tweet This Post

What are the disadvantages and side effects of cortisone injections?

Posted on by
Reply

Disadvantages of cortisone injections are the necessity of piercing the skin with a needle as well as potential short- and long-term side effects. It should be emphasized that though each of these side effects is possible, they usually do not occur.

Short-term side effects are uncommon but include shrinkage (atrophy) and lightening of the color (depigmentation) of the skin at the injection site, introduction of bacterial infection into the body, local bleeding from broken blood vessels in the skin or muscle, soreness at the injection site, and aggravation of inflammation in the area injected because of reactions to the corticosteroid medication (postinjection flare). Tendons can be weakened by corticosteroid injections in or near tendons. Tendon ruptures as a result have been reported.

In people who have diabetes, cortisone injections can elevate the blood sugar. In patients with underlying infections, cortisone injections can suppress somewhat the body’s ability to fight the infection and possibly worsen the infection or may mask the infection by suppressing the symptoms and signs of inflammation. Generally, cortisone injections are used with caution in people with diabetes and avoided in people with active infections. Cortisone injections are used cautiously in people with blood-clotting disorders.

Long-term side effects of corticosteroid injections depend on the dose and frequency of the injections. With higher doses and frequent administration, potential side effects include thinning of the skin, easy bruising, weight gain, puffiness of the face, elevation of blood pressure, cataract formation, thinning of the bones (osteoporosis), and a rare but serious damage to the bones of the large joints (avascular necrosis).

Post to Twitter Tweet This Post

Exercise can help FMS

Posted on by
Reply

by Claudia Botthof
Many people don’t exercise because they associate exercising with uncomfortable pain. Then how can people with Fibromyalgia syndrome (FMS) who live with constant pain be encouraged to exercise?

Pain is a “normal” almost accepted part of daily life. Morning stiffness, reduced joint mobility, muscular weakness, cardio respiratory impairment, poor posture, sleep deprivation, anxiety and depression are all symptoms that a person with FMS has to live with. In fact, about five million Americans (2 percent) mostly females between the ages 20 and 65 suffer from this body-wide pain disorder.

The cause is still unknown, but some research shows abnormalities in the central and peripheral nervous system. Treatment therefore is also difficult to prescribe. It usually takes a combination of medical and natural healing professions to relieve symptoms and to promote well-being. One of the effective treatments is exercise.

The key to exercising with FMS is to start very slow. For instance, aerobic activities, such as walking, will improve cardiovascular function and will help in reducing body weight. Start with five to ten minutes each day and add one minute after several days until 30 to 60 minutes of continuous walking is reached.

Water exercising is also a great opportunity. The body weight is reduced by 90 percent when walking in armpit deep water. Water also gives the body 12 times the resistance of air and therefore requires muscle strength and endurance. Besides, water relieves muscle spasm and reduces the feeling of pain. Range of motion can be greatly increased when moving the limbs through it.

Yoga is another modality that is good for relieving stress, muscle tension and muscular strength. Yoga focuses on breathing and relaxing while holding a pose. It increases strength and at the same time stimulates organs and glands, increases blood flow and helps people let go of anxiety and stress. Most of all, it focuses on posture and muscle balance, which usually worsens over time due to muscle spasm and tightness.

Strength training is also important. Weight training with light weights and few repetitions are recommended. Even though at the beginning, the body perceives exercising as painful, over time strengthening exercises will be less painful and the benefits out-weigh the uncomfortable feeling. Weight training will strengthen the muscles, increase metabolism and boost self-esteem, functional ability and self-reliance.

Generally, exercise produces hormones such as serotonin and adrenalin which are natural inhibitors of pain. Exercises will naturally improve sleep at night and therefore will improve mood and productivity throughout the day. Furthermore, exercising will prevent further deterioration of muscle weakness, immobility and flexibility.

The perception of exercising is important for improvements to occur in people with FMS. Believing it is helpful will go a long way. Over-doing it, however, will cause flare-ups and drop-outs. Again, starting slowly and progressing at a slow rate is the key in helping to win the battle of constant pain.

Post to Twitter Tweet This Post

Fibromyalgia Patients Show Decreases In Gray Matter Intensity

Posted on by
Reply

ScienceDaily (June 18, 2009) — Previous studies have shown that fibromyalgia is associated with reductions in gray matter in parts of the brain, but the exact cause is not known. Using sophisticated brain imaging techniques, researchers from Louisiana State University, writing in The Journal of Pain, found that alterations in levels of the neurotransmitter dopamine might be responsible for gray matter reductions.

For the study, magnetic imaging resonance data from 30 female fibromyalgia patients were compared with 20 healthy women of the same age. The primary objective of the study was to confirm original findings about reduced gray matter density in a larger sample of fibromyalgia patients. They explored whether there is a correlation between dopamine metabolic activity and variations in the density of gray matter in specific brain regions.

Results showed there were significant gray matter reductions in the fibromyalgia patients, which supports previous research. In addition, the fibromyalgia patients showed a strong correlation of dopamine metabolism levels and gray matter density in parts of the brain in which dopamine controls neurological activity.

The authors concluded that the connection between dopamine levels and gray matter density provide novel insights to a possible mechanism that explains some of the abnormal brain morphology associated with fibromyalgia.

Post to Twitter Tweet This Post

Pain In Fibromyalgia Is Linked To Changes In Brain Molecule

Posted on by
Reply

ScienceDaily (Mar. 13, 2008) — Researchers at the University of Michigan Health System have found a key linkage between pain and a specific brain molecule, a discovery that lends new insight into fibromyalgia, an often-baffling chronic pain condition.

In patients with fibromyalgia, researchers found, pain decreased when levels of the brain molecule called glutamate went down. The results of this study, which appears in the journal Arthritis and Rheumatism, could be useful to researchers looking for new drugs that treat fibromyalgia, the authors say.

“If these findings are replicated, investigators performing clinical treatment trials in fibromyalgia could potentially use glutamate as a ‘surrogate’ marker of disease response,” says lead author Richard E. Harris, Ph.D., research assistant professor in the Division of Rheumatology at the U-M Medical School’s Department of Internal Medicine and a researcher at the U-M Chronic Pain and Fatigue Research Center.

The molecule glutamate is a neurotransmitter, which means it conveys information between neurons in the nervous system. When glutamate is released from one neuron, it diffuses across the space between cells, and then binds to receptors on the next neuron in line and causes the cell to become excited, or to be more active.

This molecule was suspected to play a role in fibromyalgia because previous studies had shown that some brain regions in fibromyalgia patients appear to be highly excited. One such region is the insula.


In functional magnetic resonance imaging (fMRI) studies, researchers at U-M had previously shown that the insula displays augmented activity in fibromyalgia, which means neurons in these patients are more active in this part of the brain. The U-M team hypothesized, Harris notes, that more activity among these neurons might be related to the level of glutamate in this region.

To gauge the linkage between pain and glutamate, the researchers used a non-invasive brain imaging techinique called proton magnetic resonance spectroscopy (H-MRS). H-MRS was performed once before and once following a four-week course of acupuncture or “sham” acupuncture.

Researchers used either acupuncture or sham acupuncture to reduce pain symptoms. The sham procedure involved using a sharp device to prick the skin in order to mimic real acupuncture sensations.

Following the four weeks of treatment, both clinical and experimental pain reported were reduced significantly. More importantly the reduction in both pain outcomes was linked with reductions in glutamate levels in the insula: patients with greater reductions in pain showed greater reductions in glutamate. This suggests that glutamate may play a role in this disease and that it could potentially be used as a biomarker of disease severity.

Because of the small number of participants in this study, further research should be conducted to verify the role of glutamate in fibromyalgia, Harris says.

The senior author of the study was Daniel J. Clauw, M.D., director of the U-M Chronic Pain and Fatigue Research Center. Other authors were Richard H. Gracely, Ph.D., and Seong-Ho Kim, M.D., of the U-M Department of Internal Medicine; Pia C. Sundgren, M.D., Ph.D., Yuxi Pang, Ph.D., and Myria Petrou, M.D., of the U-M Department of Radiology; Michael Hsu, M.D., of the U-M Department of Physical Medicine and Rehabilitation; and Samuel A. McLean, M.D., of the U-M Department of Emergency Medicine.

Funding came from a Department of Army grant, the National Institutes of Health, and the NIH National Center for Complementary and Alternative Medicine.

Reference: Arthritis and Rheumatism, March 2008, Volume 58, Issue 3, “Dynamic Levels of Glutamate within the Insula are Associated with Improvements in Multiple Pain Domains in Fibromyalgia.”

Post to Twitter Tweet This Post

Nutra Pharma Announces Launch of Cobroxin, an Over-the-Counter (OTC) Treatment for Stage 2 (Moderate to Severe) Chronic Pain

Posted on by
Reply

PLANTATION, Fla.–(BUSINESS WIRE)–Nutra Pharma Corp. (OTCBB: NPHC), a biotechnology company that is developing treatments for Adrenomyeloneuropathy (AMN), HIV and Multiple Sclerosis (MS), has announced today that it has launched an over-the-counter (OTC) pain reliever, Cobroxin, for the treatment of Stage 2 (moderate to severe) chronic pain.

Cobroxin is the first OTC pain reliever clinically proven to treat Stage 2 (moderate to severe) chronic pain. The drug, which was developed by Nutra Pharma’s wholly-owned drug discovery subsidiary, ReceptoPharm, will be available as an oral spray for treating lower back pain, migraines, neck aches, shoulder pain, cramps and neuralgia and as a topical gel for treating repetitive stress, arthritis, and joint pain.

Additional benefits to Cobroxin include:

* All Natural
* Non-Addictive
* Non-Narcotic
* Non-Opiate
* More Potent than Morphine
* Long Lasting

“Cobroxin is a next generation pain reliever that addresses physician and consumer demand for a safer and less costly treatment for chronic pain,” commented Rik J Deitsch, Chairman and CEO of Nutra Pharma Corporation. “Cobroxin provides affordable and accessible pain relief for those without healthcare coverage, for those looking for a safer and effective treatment for pain, and for those not receiving effective or lasting relief from OTC NSAIDs,” he added.


Pain is the single most common reason patients seek medical care and accounts for half of all physician office visits in the United States. According to the American Pain Foundation, each year, more than 25 million people in the United States experience acute pain as a result of injury or surgery. Additionally, more than 50 million people in the United States are affected by ongoing chronic pain.

Current treatments for chronic pain include both opiate-based analgesics including Vicodin, Percocet, and Morphine, and those containing acetaminophen, such as Tylenol. Debate surrounding the use of opiates primarily focuses on the negative side effects observed with opiate-based analgesics, including nausea, vomiting, drowsiness, itching, constipation, respiratory depression, addiction, severe withdrawal symptoms and the buildup of tolerance, requiring higher dosage over time to experience the same effect. Additionally, recent media coverage has highlighted the dangers of using analgesics containing acetaminophen, which, in higher dosages, can cause liver damage or even death.

“What differentiates Cobroxin from other current analgesics is that it uses a novel mechanism of action discovered from cobra venom peptides for treating pain without the negative side effects observed in current opiate-based analgesics and those containing acetaminophen,” explained Dr. Paul Reid, CEO of Nutra Pharma’s wholly-owned drug discovery subsidiary, ReceptoPharm. “With extensive supporting evidence from 46 human clinical studies and a well-defined safety profile, we believe that Cobroxin will soon become the preferred method for treating chronic pain,” he concluded.

In preparation for commercializing Cobroxin, Nutra Pharma recently announced that ReceptoPharm had filed a patent application for a novel composition and method for oral delivery of cobra venom for the treatment of pain. The company plans to begin marketing and selling Cobroxin upon successful submission of final packaging and labeling to the FDA.

About Nutra Pharma Corp.

Nutra Pharma Corp. is a biopharmaceutical company specializing in the acquisition, licensing and commercialization of pharmaceutical products and technologies for the management of neurological disorders, cancer, autoimmune and infectious diseases. Nutra Pharma Corp. through its subsidiaries carries out basic drug discovery research and clinical development and also seeks strategic licensing partnerships to reduce the risks associated with the drug development process. The Company’s subsidiary, ReceptoPharm, Inc., is developing these technologies for the production of drugs for HIV and Multiple Sclerosis (“MS”). The Company’s subsidiary, Designer Diagnostics, is engaged in the research and development of diagnostic test kits designed to be used for the rapid identification of infectious diseases such as Paratuberculosis (para-TB) and Mycobacterium avium-intracellulare (MAI). Nutra Pharma continues to identify and acquire intellectual property and companies in the biotechnology arena.

Post to Twitter Tweet This Post

My Fibro, by unknown

Posted on by
Reply

I first had symptoms in 1983 (twenty three years old) shortly after a case of Mononucleosis. I went to my doctor with fatigue and joint pain and she explained that a “rheumatoid effect” can occur for 3 to 5 years after having Mono and prescribed meds to treat the symptoms. I had multiple symptoms over the years then, in 1991, I complained to my doctor about my neck pain. He said it was “a little fibromyalgia” and left it at that, like it was nothing. Pain went untreated and symptoms waxed and waned until a client of mine who was a surgeon sent me to an orthopedic doctor who gave me a diagnosis of Fibromyalgia.

In 2000 or 2001 I finally found a doctor who really knew what he was talking about when it came to treating FMS. He said I also have Chronic Myofascial Pain Syndrome (CMPS is now CMP as it was recognized as an illness this past year, rather than a “syndrome” so now they finally realize we’re not all crazy). I read several books by Devin Starlanyl who is a doctor that researches Fibro and CMP, and also suffers along with us. It was so validating to read about it and know I wasn’t alone. My new doctor prescribed pain medications that actually work.

I have suffered depression since I was a teenager and one doctor, when I was about 36, tried to treat me with Lithium for bipolar disorder. The medication had terrible side effects so I quit. My incidents of “mania” are minimal so I left it untreated and just took antidepressants.

My current doctor is the first I’ve ever trusted enough to try new medication which has helped perk me up a lot and I have requested several reductions in pain medication so I guess I’m doing OK, considering. I have talked to people with FMS who are only slightly bothered by it all the way to one who was in a wheel chair. I manage mine, as well as other conditions, with meds, a lot of rest and the support of a great husband.

Twenty six years is a long time to be in pain. I’m looking forward to reading your stories, The only recommendation I have is to keep looking until you find a doctor whom you can trust, that knows what he’s doing and doesn’t dismiss your pain.

Post to Twitter Tweet This Post