Tag Archives: pain
Migraine, Chronic Back Pain Tied to Higher Suicide Risk
WEDNESDAY May 22, 2013 — People who endure chronic migraines or back pain are more likely to attempt suicide, whether or not they also suffer from depression or another psychiatric condition, according to a new study.
“Clinicians who are seeing patients with certain pain conditions should be aware they are at increased risk of suicide,” said study co-author Mark Ilgen, of the Veterans Affairs Serious Mental Illness Treatment Resource and Evaluation Center in Ann Arbor, Mich.
“Although undoubtedly psychiatric factors are important, there might be aspects of the pain that in and of themselves increase a person’s risk,” Ilgen said. “There might be something about someone with significant pain that puts them at increased risk.”
The wide-ranging study, published online May 22 in the journal JAMA Psychiatry, involved more than 4.8 million people who received care from the U.S. Veterans Health Administration during fiscal year 2005. Researchers identified those suffering from chronic pain and tracked them for the next three years to see if any died from suicide.
The research team then looked for associations between suicide death — the 10th most common cause of death in the United States — and clinical diagnoses of chronic pain conditions, such as arthritis, back pain, migraines, neuropathy, headaches or tension headaches, fibromyalgia and psychogenic pain.
They found that all pain conditions except arthritis and neuropathy were associated with elevated suicide risk. But when they took into account the mental-health problems that chronic pain patients also had, the associations reduced for all but three types of chronic pain: back pain, migraines and psychogenic pain, which stems from psychological factors.
Dr. Elspeth Cameron Ritchie, a retired Army colonel and psychiatrist living in Washington, D.C., said the study clearly reinforces the anecdotal link between pain and suicide.
“It makes sense that pain is a risk factor for suicide,” she said. “Often, suicide has several different things going on, but pain can be the straw that breaks the camel’s back in terms of a person’s decision not to go on.”
Therapists performing a suicide-risk evaluation should consider adding a question regarding pain to the standard questions aimed at suicidal thoughts and planning, she said.
“It’s not a standard question: ‘Are you in pain?’” Ritchie said. “I would ask, ‘Are you in pain?,’ or ‘Is pain an issue for you?’”
Psychogenic pain increased people’s risk of suicide the most, followed by migraines and back pain. Psychogenic pain is chronic pain caused or exacerbated by mental or emotional problems, and Ilgen said it is a rare and not well understood condition.
“We think that’s not so much about psychogenic pain per se, but the fact that the pain itself is poorly understood and may be poorly managed,” Ilgen said. “There’s not a clear treatment plan for that type of pain. It’s likely that patients with this type of pain may be frustrated with their care and more hopeless and more at risk for suicide.”
Hopelessness also could play a part in the elevated risk of suicide for migraine and chronic back pain sufferers — two common problems in the United States. Back pain, for instance, is the second most common pain complaint among Veterans Health Administration patients, behind only arthritis.
“Patients with these pain conditions also may be more likely to feel hopeless and to have impairments in occupational or social functioning that could lead more directly to suicidal thoughts and behaviors,” according to the study.
“Negative expectations about one’s ability to effectively manage or treat pain could lead to suicidal ideation, and these effects might be greatest for certain conditions, such as psychogenic pain, that do not have clear or effective treatments and may be stigmatized,” the researchers said.
Disability also could be a factor in the increased suicide risk, particularly for people with back pain who used to be healthy and active, Ritchie said.
Ilgen said it is not known whether there are unique warning signs of suicide for chronic pain patients. He urged family and friends of patients to keep a close eye out for standard warning signs, such as intense depression, expressions of hopelessness, statements about suicidal thoughts or plans, or any indication that the person is not oriented toward the future.
“My best recommendation is to encourage the patient to reach out for professional help,” Ilgen said. “Ask about their suicidal thoughts. Don’t just skirt the issue; directly ask.”
More information
The U.S. National Institute of Mental Health has more about suicide prevention.
Posted: May 2013
Antibiotics May Relieve Back Pain Symptoms
By Peter Russell
WebMD Health News
Reviewed by Farah Ahmed, MD
May 10, 2013 — Taking antibiotics could relieve symptoms of chronic lower back pain for up to 40% of people, according to a new study.
Danish researchers say they’ve found a link between many cases of back pain and infection from bacteria.
Some experts have questioned how many people are likely to benefit from this treatment. Others have cautioned that boosting antibiotic use in the face of growing resistance could be counterproductive and lead to more superbugs.
Widespread Complaint
Back pain is a common condition, affecting about 4 out of 5 people at some point in their lives.
Recommended treatments include painkillers, hot or cold compresses, lifestyle changes, physical therapy, and keeping active. In extreme cases, when other treatments have failed, surgery may be carried out to remove part of a damaged disc.
Bacterial Infection
The latest studies from the University of Southern Denmark build on previous research, which shows that between 7% and 53% of patients with herniated discs have a type of bacteria. In these patients the bacteria entered the disc at the time it was herniated, or “slipped.”
In the first study of 61 patients who had spinal surgery for lower back pain, the researchers found bacteria in 46% of the slipped discs.
In a second study, the research team recruited 162 patients who had been living with low back pain for more than 6 months following a slipped disc. Half of the patients were given a 100-day course of antibiotic treatment, while the others received a placebo.
After a 1-year follow-up period, those who’d taken antibiotics were less likely to still have lower back pain and physical disability. They were also less likely to have leg pain and to have taken days off work because of their back.
The researchers estimate that about 35% to 40% of people with long-term back pain have excess fluid in the spinal vertebrae and might benefit from this type of treatment.
The findings are published in the European Spine Journal.
‘Not a Cure’
Media reports that antibiotics could be a cure for back pain have alarmed John O’Dowd, a consultant spinal surgeon and president of the British Society for Back Pain Research.
“Unless you’ve had a disc herniation … I don’t think you should be getting too excited, and I don’t think this is going to be a treatment for you,” O’Dowd says. ”I think this is another useful building block of evidence, but I don’t think it’s either a cure or the answer to back pain.”
Low-Dose ‘Pill’ Linked to Pain During Orgasm, Study Finds
Women on low-estrogen formulations report more pain overall, and during sex
WebMD News from HealthDay
By Kathleen Doheny
HealthDay Reporter
FRIDAY, May 3 (HealthDay News) — Women taking birth control pills with lower amounts of estrogen — a commonly prescribed contraceptive — may be at higher risk for chronic pelvic pain and pain during orgasm, according to new research.
A study of nearly 1,000 women found that women on the lower-dose oral contraceptives were more likely than those on the standard dose (with higher estrogen levels), or those not on the pill, to report pelvic pain.
“In our practice, we have seen a lot of this anecdotally,” said Dr. Nirit Rosenblum, assistant professor of urology at NYU Langone Medical Center in New York City, a specialist in female pelvic medicine and reconstructive surgery.
To investigate the potential link further, she compared pain symptoms of women on low-dose birth control pills with those not on pills and those on standard doses.
She is scheduled to present the findings Tuesday at the American Urological Association’s annual meeting in San Diego, but acknowledged additional research is needed to understand the association.
For her study, Rosenblum defined low-dose birth control pills as those that contain less than 20 micrograms (mcg) of synthetic estrogen. (The name often includes the word “lo.”) Those that have 20 mcg or more are “standard” or normal dose.
When natural estrogen production declines at menopause, women can begin to experience pelvic pain, Rosenblum said.
To see if low-estrogen birth control pills might mimic those effects, she evaluated the online survey responses of 932 women, aged 18 to 39, associated with two large universities. Women with a history of pelvic pain, the painful pelvic condition endometriosis or any who were pregnant were excluded from the study.
Women reported if they were on the pill or not and which dose pill. Of the 327 women taking birth control pills, about half used a low-dose pill. The other 605 women did not take the pill.
The women answered questions about pain. Twenty-seven percent of those on a low-dose pill had pelvic pain symptoms or reported chronic pelvic pain compared to 17.5 percent of those not on the pill.
Those on normal-dose pills were less likely to have pelvic pain overall than those not on the pill, she found.
Low-dose pill users were twice as likely to report pain during or after orgasm than those not on the pill: 25 percent versus 12 percent. Those on higher-dose pills reported no difference in pain at sexual climax than those not using birth control pills.
Dr. Christopher Payne, a professor of urology at Stanford University School of Medicine and director of its division of female urology, said the information could be helpful. However, “I don’t know if we can draw any conclusions from this,” he added.
Using Marijuana to Treat Pain? A Pill May Outlast a Puff
Study shows a pill containing THC lasts longer and may be safer than smoking pot
WebMD News from HealthDay
By Brenda Goodman
HealthDay Reporter
MONDAY, April 22 (HealthDay News) — A pill may work as well as a puff when it comes to using marijuana to treat pain, according to a small but carefully controlled new study. Pain relief from pills may last longer, however, and may not leave people feeling as high as they do after they smoke the drug.
Medical marijuana is now legal in 18 states and the District of Columbia, according to the nonprofit group ProCon.org. Surveys show pain is one of the main reasons doctors prescribe it. But studies testing marijuana as a pain reliever have had mixed results. Some have shown that it works as well as mild opioid (narcotic) pain relievers like codeine, while others have indicated that the drug might actually make pain worse.
To learn more, researchers at the Substance Use Research Center of the New York State Psychiatric Institute pitted two strengths of smoked marijuana against two strengths of the drug dronabinol, which contains tetrahydrocannabinol, or THC, the same active ingredient as in marijuana plants.
Dronabinol has been FDA-approved since 1985 to treat the nausea and loss of appetite that commonly afflict patients with cancer and AIDS. Less is known about its effects on pain.
For the government-sponsored study, researchers recruited 30 healthy, pain-free men and women who were already regular marijuana smokers.
During five experimental sessions, participants took a capsule and then 45 minutes later smoked a marijuana cigarette. The capsules contained either an inactive placebo, or 10 milligrams or 20 milligrams of dronabinol. The cigarettes were specially made by the U.S. National Institute on Drug Abuse, which funded the study. Cigarettes were standardized to contain marijuana with no THC, a low dose of the drug or a higher dose.
People in the study never knew whether they were smoking or swallowing the drug or how strong the dose was. Researchers made sure they never got a double hit of the drug during the same session.
The testing days were spaced at least two days apart, and participants were asked to refrain from smoking the night before their lab visits.
Several times during the sessions, researchers had each person place their hands in a water bath kept just above freezing temperatures. They measured how long it took study participants to feel pain and then how long they were able to tolerate the pain before they yanked their hand out of the water. Participants also answered questions about how intensely they felt the pain during the experiments and how high they felt.
When researchers tallied their data, they found that both the smoked drug and the pill were about equally effective at controlling pain.
After smoking the strongest cigarettes or taking the highest strength of the pill, it took people an average of about 12 to 13 seconds longer to report feeling pain from the cold water compared to when they took the placebos. Both forms of the drug also significantly increased pain tolerance, the amount of time a person was able to stand the pain before they pulled their hand out of the cold water.
VIDEO: Interactive video game helps patients manage pain
Danica Zimmerman uses a new movement-controlled video game specifically designed for patients as part a treatment for a pain disorder at Children’s National Medical Center. The games allow doctors to collect important data during treatment while also helping patients relax during therapy.
