Advances in pain relief

Pain, unfortunately, is a horrible necessity of life. It protects people by alerting them to things that might injure them. But some long-term pain has nothing to do with any obvious injury. One estimate suggests that one in six adults suffer from a “chronic pain” condition.

Steve McMahon, a pain researcher at King’s College, London, says that if skin is damaged — for instance with a hot iron — an area of sensitivity develops around the outside of the burn, where although untouched and undamaged by the iron, the behaviour of the nerve fibres is disrupted. As a result, heightened sensitivity and abnormal pain sensations occur in the surrounding skin. Chronic pain, he says, may similarly be caused not by damage to the body, but because weak pain signals become amplified.

This would also help explain why chronic pains such as lower-back pain and osteoarthritis fail to respond well to traditional pain therapies.

But now an entirely new kind of drug, called Tanezumab, has been developed. It is an antibody for a protein called nerve growth factor (NGF), which is vital for new nerve growth during development. NGF, it turns out, is also crucial in the regulation of the sensitisation of pain in chronic conditions.

Kenneth Verburg, one of the researchers involved in the development of Tanezumab at Pfizer, says it is not exactly clear what role NGF plays in normal physiology, but after an injury which involves tissue damage and inflammation, levels of NGF increase dramatically. The NGF seems to be involved in transmitting the pain signal. As a consequence, blocking NGF reduces chronic pain.

Tanezumab must still complete the final stages of clinical trials before it can become a weapon in the toolkit for reducing human suffering.

But unexpected pains do not always come from the body.

According to Irene Tracey, a pain researcher at the University of Oxford, how pain is experienced also depends upon a person’s state of mind. If successive patients suffer the same burn, the extent to which it hurts will depend on whether one is anxious, depressed, happy or distracted.

Such ideas are being explored with brain scans which suggest that even if a low level of pain is being sent to the brain, the signal can be turned up by the “mind” itself. Indeed, patients can even be tricked into feeling pain.

In one experiment volunteers were given a powerful analgesic and subjected to a painful stimulus — which, because of the analgesic, they could not feel. Then they were told the drug had worn off (although it had not), and subsequently complained that the stimulus hurt.

People can, therefore, feel pain simply because it is expected. They can fail to feel pain for exactly the same reasons, for example when they are given placebos or are distracted. But although pain may be subjective, that does not mean the final experience is controlled solely by the mind.

A recent paper in Proceedings of the National Academy of Sciences has shown that genes play a role in determining sensitivity to pain.

One gene, known as SCN9A, codes for a protein that allows the channels along which nerve signals are transmitted, to remain active for longer, and thus transmit more pain signals. It seems likely that this protein will attract a great deal more analgesic research. Variations in SCN9A may also explain why some patients prefer different classes of painkillers.

Although pain may be a horrible necessity, there is no doubt that humanity could cope with far less of the chronic sort. Understanding how the mind, the body and people’s genes interact to cause pain should bring more relief.

Shoulder Pain : What are the causes?

The important thing to understand is that shoulder pain can be indicative of pathologies very different from each other.

The shoulder is a joint (or even more joints) suspended (the arm is "hooked" to the trunk) which explains that the muscle and tendon disorders are more frequent and certainly more meaningful (in terms of pain) that the conditions of articular wear (osteoarthritis). On the other hand, some pain may be felt in the shoulder pain but be "projection" of pulmonary origin, cervical ...

It thus distinguishes:
The causes bone and joint:

• Osteoarthritis is primitive or secondary (in the context of neurological diseases such as syringomyelia, where one is struck by the discrepancy between impressive osteoarthritic lesions on radiographs and pain discrete)
• Infectious causes (very rare, ranging from acute septic arthritis to tuberculosis).

Bone Tumors-benign or malignant.
The adhesive capsulitis of the shoulder
Pathology frequent Échez diabetics where the mobility of the shoulder is very limited, with pain at night, but the radiograph is almost normal.

The pathology or peri juxta articular shoulder
which is the dominant pathology
Either-table "tendinitis" microtrauma, muscles responsible for rotation of the shoulder, which appears especially after forty.
Either-inflammatory acute due to the precipitation of microcrystals in a bursa located between the muscles, giving an acute pain in the shoulder with limitation, but often dramatically effective treatment with anti-inflammatory drugs and colchicine.

• Let tramatique disease or injury with rupture of a tendon muscle cuff of the shoulder.

The pain of the shoulder projection
quite frequent.
Sorrows of pulmonary origin (taking radiographs of the lungs especially in smokers).
Pain-neck (in association with a cervico-brachial neuralgia).

• A special mention for the pain of biliary origin (gallstones) sometimes revealed by a pain in the right shoulder.
• Beware of cardiac pain, especially on the left.

In short, it is the doctor to examine the patient to take a good diagnostic orientation before they do further tests.

What is Chronic Pain

Currently, chronic pain is not recognized as a disease in itself, by any medical authority. One of several Body Pain, Chronic Pain is also a severe form of Pain. In the health community, there are two schools of thought. The first, more traditional, argues that this is only a symptom, such as acute pain. The second considers the chronic pain as a disease because of the neurochemical changes that occur in people with chronic pain.

We can compare the chronic pain in an alarm bell that no longer able to extinguish. Thus, the pain persists ... for nothing.

This disorder is growing. In fact, family physicians are increasingly arriving in their offices for patients afflicted with chronic pain. If the causes are sometimes recognizable, other times they are inexplicable. The health professionals are confronted with their own powerlessness.

Consider increasing chronic pain as a disease of the nervous system, one among main body pains But not all agree on its definition. But what is a chronic pain? In short, it is a pain that lasts longer than six months. This pain can be constant or intermittent, such as migraines. It may be linked to chronic diseases such as Osteoarthritis or Rheumatoid Arthritis. These two diseases are also major causes of chronic pain.

Where is the harm? The back is the part of the body most often affected by chronic pain. Then there are the legs, head, neck, knees and abdomen. It can be caused by injury to nerves, to muscles, joints or body.

Symptoms of Lower Back Pain

Due to the complex anatomy of the lumbar spine and the multiple causes of pain in his lower back, symptoms can vary greatly from person to person. For the same condition, two people can describe their pain very differently.

• If the pain in his lower back occurs suddenly and is manifested by a sudden and intense contraction of muscles is usually a sign of muscle damage, sprained ligaments, breaking or removal of a disc.
• If pain culminates in the morning and diminishes with movement and stretching, it may be a muscle trauma or of osteoarthritis.
• When the pain goes down along the posterior part of one or both legs, it is neuralgia sciatica. The pain is then exacerbated by coughing, sneezing or exercise. This type of pain can be a sign of a herniated disc.
• If the pain in the lower back is worse at night and is not relieved by exercise, it can be caused by pressure exerted by inflammation, a diseased organ or a tumor.

What causes Lower Back Pain ?

Back pain is a symptom. It is therefore important to identify the source of evil to find the best treatment. The causes of back pain are varied. Often it is difficult to pinpoint the origin of evil.

Here are the sources of pain the most frequent.

• An injury to a muscle, tendon or ligament. An effort or unusual twist or accumulation of microdamage caused by repetitive motion may be the cause. People in poor physical condition are most at risk.
• The disc degeneration. Between each vertebrae there are kinds of small cushions called intervertebral discs. They help absorb shock and provide flexibility to the spine. With aging, discs lose their elasticity. It shows a disc degeneration in almost all persons over 60 years. Some athletes also experience this problem around the quarantine, especially those who practice an activity that creates pressure on the spine.
• A herniated disc. A portion of the gel content in the intervertebral disc protrudes outward and compresses the nerve roots. Poor posture, excess weight, pregnancy and disc degeneration are major causes of disc herniation.
• A gynecological problem. Many women have back pain on a regular or constant, because of painful periods, of endometriosis, etc..
• Slippage of one vertebra onto another vertebra (spondylolisthesis). This situation can occur due to a congenital weakness in the vertebral structures or following trauma.
• Arthritis, osteoarthritis or osteoporosis. These health problems are common among the elderly. If the osteoporosis of the spine is important, it can cause a vertebral fracture.

Whatever the origin of back pain, there is often a contraction of muscles around the painful area. It is a protective reflex. This contraction may itself cause the pain. A vicious cycle can then begin and contribute to chronic pain.