New Pain Mechanisms Revealed

Neuropathic pain is a chronic pain condition caused by a damaged or dysfunctional nervous system. It is characterised by shooting and burning pain that lasts long after the initial onset. Common causes of neuropathic pain include:

• alcoholism
• amputation
• back, leg and hip problems
• chemotherapy
• diabetes
• facial nerve problems
• HIV or AIDS
• multiple sclerosis
• shingles
• spine surgery

Unfortunately neuropathic pain doesn’t respond much to conventional analgesics but instead, antidepressants (amitriptyline and duloxetine) and anticonvulsants (gabapentin and pregabalin) have been found to help relieve pain.

A new study published in this month’s edition of Neuron by Thomas Nevian et al from the Department of Physiology at the University of Bern has revealed some of the mechanisms involved in neuropathic pain. In a mouse model, they found that neurons in the gyrus cinguli, a part of the brain found in the limbic system (usually associated with emotion) are modified by pain forming a “pain memory”. Neurons in the gyrus cinguli become more excitable due to a down-regulated ion channel. This leads to an increased number of nerve impulses which the brain perceives as pain.

The researchers managed to restore the function of the ion channel by activating a receptor sensitive to serotonin. This explains the success of some antidepressants in treating neuropathic pain. Nevian et al were able to identify the specific subtype of serotonin receptor that was more efficient at reducing the perception of pain. Excitingly, this could lead to the development of more effective drugs to treat neuropathic pain.

Meditation Decreases Chronic Neck Pain

A group of German researchers recently published the results of a study looking into the benefits of meditation on people with chronic neck pain. The article was published in The Journal of Pain. They studied about 90 people who had neck pain for an average of 11 years. The average age of the participants was 50 years. Their results found significant improvements in pain reduction and pain coping but no effect on functional disability.

The findings suggest that meditation could be used as an adjunct alongside physical treatments that provide functional benefits.

The Miracle Cure

Scarlett McNally, a Consultant Orthopaedic surgeon, and her colleagues have spent 2 years analysing more than 200 separate pieces of research. The effect that regular exercise could have on our health is amazing. Exercise could:

• prevent type 2 diabetes
• reduce the risk of getting breast cancer by 25%
• decrease the risk of bowel cancer by 45%
• reduce the risk of having a stroke by 30%
• reduce the risk of developing dementia by 30%
• cut the risk of developing heart disease by over 40%
• as well as improvements to mental health

Exercise doesn’t have to be vigorous but it should be regular. Simply start by increasing your physical activity in whatever way you can: walk more, take the stairs, do some gardening, ride a bike…the possibilities are endless!

What Triggers Low Back Pain?

A study published this month in Arthritis Care and Research by Daniel Steffens et al. from the University of Sydney has looked at the risk factors that could lead to acute low back pain. Acute low back pain is back pain that comes on suddenly and resolves after a few days or weeks as opposed to chronic low back pain which is long-standing.

They surveyed close to 1000 people and asked them about the presence of 12 physical and psychosocial factors up to 4 days before the onset of back pain. The results revealed that a number of triggers were linked to acute low back pain:

• moderate to vigorous physical activity increased the risk by 3
• manual tasks involving awkward postures increased the risk by 8
• being distracted during an activity increased the risk by 25
• age decreased the effect of exposure to heavy loads
• risk was highest between 7 am and mid-day

Over the years, I’ve noticed that the parents of young children have an increased incidence of low back pain. Having seen some of the risk factors high-lighted in this study, it becomes evident how sleep-deprived, fatigued and distracted parents that often lift their children in awkward positions can dramatically increase the risk of low back pain. It’s also interesting to note that distraction seems to massively increase the risk of low back pain and therefore underlines the importance of mindfulness.

Sleep Quality Linked to Rumination

Jacob Nota and Meredith Coles from the Department of Psychology at Binghamton University in the US have made some interesting discoveries regarding sleep duration and timing. Their research confirmed what others had already noticed, that rumination (repetitive negative thinking) was associated with reduced sleep duration. In addition to this, they found that the timing of sleep was also important. Individuals that reported later sleep and activity times also reported more repetitive negative thinking.

People that ruminate tend to suffer more from anxiety, depression, post-traumatic stress disorder and obsessive-compulsive disorders. For those that sleep too few hours, increasing sleep has already been found to decrease symptoms of psychopathology. Further efforts to get to bed earlier may provide even more benefit.

These recent findings highlight the importance of sleep on health.

Diabetes Linked To Shoulder & Hand Pain and Disability

A recent study by Shah et al. found that about two-thirds of patients attending a diabetes outpatient clinic reported shoulder pain and/or disability. They had significant restrictions in shoulder movement, decreased shoulder strength and hand grip strength. In addition to this, they had a greater likelihood of decreased sensation and limited mobility of the hand. Further research is needed to understand the underlying mechanisms and to find preventative measures.

Side Planking Reduces Scoliosis

Dr Loren Fishman et al. studied a group of 25 patients with scoliosis. They taught the patients how to perform the side plank, which is a static exercise performed in Yoga and Pilates. The patients were then asked to perform the exercise once a day for as long as possible. They were instructed to only perform it on one side, with the scoliotic convexity downwards. The theory being that it would strengthen the weaker side of the spine and help address the muscle imbalance.

Measurements and x-rays were taken pre and post treatment. On average, patients reported practising the pose for 90 seconds a day, 6 days a week, for just under 7 months. A significant improvement of 32% was found in the Cobb angle of the primary scoliotic curve. The improvement rose to above 40% among the 19 most compliant patients.

This is an amazing result given the minor time investment!

Low Level Physical Activity Benefits Knee Osteoarthritis

It’s well known that increasing the time spent doing moderate intensity physical activities has wide ranging benefits on health. Guidelines recommend 150 minutes a week of moderate to vigorous physical activity. What about those unable to engage in moderate or vigorous physical activities due to health issues? Could light physical activity work too?

A study by professor Dunlop et al. looked at the effects of physical activity in people with knee osteoarthritis or risk factors for knee osteoarthritis. As well as finding benefits to moderate activity, they found that spending more time doing light intensity physical activities reduced the risk of onset and progression of disability due to osteoarthritis. They concluded that “an increase in daily physical activity time may reduce the risk of disability, even if the intensity of that additional activity is not increased.”

Breathing Exercises Help Treat PTSD

A study by Seppala et al, published in last month’s issue of the Journal of Traumatic Stress, looked into the effects of yogic breathing on war veterans with post traumatic stress disorders (PTSD). They found that after the course of controlled breathing exercises the test subjects had reductions in PTSD scores, anxiety symptoms, respiration rate, startle signs and other hyperarousal symptoms. The benefits were still present 1 year later. It’s thought that the breathing exercises help balance the autonomic nervous system.

Yoga Improves Mental Function

Gothe et al. from the University of Illinois recently conducted a study to look into the effects of hatha yoga on cognition. They recruited 118 senior citizens (mean age of 62) and randomly assigned them to one of 2 groups: a hatha yoga intervention group and a stretching/strengthening control group. Each group took part in hour-long exercise classes 3x/week for 8 weeks. At the end of the study period the yoga group showed improved results at information recall, mental flexibility and task switching. Whereas the stretching/strengthening group showed no improvement.

Although the underlying mechanisms are not known, it’s possible that the improvements in mental function may have been secondary to a reduction in stress. Alternatively, they may be down to the focussed attention on breathing, body position and movement.