Pain Management

Posted on Pain Management

Using ergonomics to reduce pain from technology use

How to prevent autism burnout

The use of smartphones, tablets and laptops has become commonplace throughout the world and has been especially prevalent among college students. Recent studies have found that college students have higher levels of screen time, and they utilize multiple devices at higher rates compared to previous generations.

With the increased use of these devices, especially smartphones, students tend to use a less-traditional workplace such as a couch or chair with no desk, leading to an increase in musculoskeletal disorders in that age group. A team of Texas A&M researchers led by Mark E. Benden conducted a study looking at the technology students use, the postures they adapt when they use their devices, and the amount of pain the students were currently experiencing.

Benden and his co-authors found that smartphones have become the most common link to educational materials though they have the least favorable control and display scenario from an ergonomic perspective. Additionally, the team concluded that regardless of device, ergonomic interventions focused on improving posture and facilitating stress management may reduce the likelihood of pain.

The results of the team’s study were published recently in the open-access, peer reviewed journal BMC Public Health.

“When we started this study a few years ago it was because we had determined that college students were the heavy users of smartphones,” Benden said. “Now those same levels we were concerned about in college students are seen in 40-year-olds and college students have increased to new levels.”

Benden, professor and head of the Department of Environmental and Occupational Health (EOH) at the Texas A&M University School of Public Health and director of the Ergo Center, co-authored the study with EOH associate professors Adam Pickens, S. Camille Peres, and Matthew Lee Smith, Ranjana Mehta, associate professor in the Wm Michael Barnes ’64 Department of Industrial & Systems Engineering, Brett Harp, a recent EOH graduate, and Samuel Towne Jr., adjunct assistant professor at the School of Public Health.

The research team used a 35-minute online survey that asked participants about their technology use, posture when using the technology, current level of pain or discomfort, and their activity and stress levels.

Among the respondents, 64 percent indicated that their smartphone was the electronic device they used most frequently, followed by laptops, tablets and desktop computers. On average, the students used their smartphone 4.4 hours per day, and they indicated that when doing so, they were more likely to do so on the couch or at a chair with no desk.

“It is amazing to consider how quickly smartphones have become the dominant tech device in our daily lives with little research into how that level of use would impact our health,” Benden said.

The researchers found that posture components and stress more consistently contributed to the pain reported by the students, not the variables associated with the devices they were using.

Still, the researchers point out that in our ever-increasing technology-focused society, efforts are needed to ensure that pain is deferred or delayed until an individual’s later years to preserve the productivity of the workforce.

“Now that we are moving toward hybrid and/or remote workspaces for our jobs, college students are taking habits formed in dorm and apartment rooms during college into young adulthood as employees in home offices,” Benden said. “We need to get this right or it could have adverse impacts on an entire generation.”

Posted on Pain Management

Killing pain without hurting the body: Novel compound that is potentially safer than current drugs

Pharmacodynamics and Pharmacokinetics of AD732: A Novel Pyrazole Derivative

Novel compound “AD732” shows analgesic and anti-inflammatory properties, but with fewer side effects than standard non-steroidal painkillers CREDIT Ritsumeikan University, Japan

Muscular pain, osteoarthritis, inflammatory bowel disease, and headaches have something in common—they are the result of various inflammatory processes that occur inside our body. The standard treatment, among other recourses, includes administration of non-steroidal anti-inflammatory drugs (NSAIDs). By inhibiting either of the enzymes (cyclooxygenase-1 or -2, also known as COX-1/COX-2) present in abundance at biological sites of inflammation, NSAIDs minimize pain and combat inflammation. But there’s a flip side—they can also cause serious side effects that result in heart failure, kidney malfunction, and stomach ulceration. It appears that to kill pain, we hurt our bodies.

This is why, for some time, efforts have been directed at finding safer non-steroidal anti-inflammatory and analgesic drugs. Most recently, a compound labeled AD732 has been synthesized, which shows promise in this direction. Now, in a new study published in the European Journal of Pharmaceutical Sciences (paper made available online on November 21, 2021, and published in Volume 168 of the journal on January 1, 2022), researchers led by Dr. Kikuko Amagase from Ritsumeikan University, Japan, and Prof. Adnan A. Bekhit, from the University of Alexandria, Egypt, have explored the therapeutic efficacy and side effects of this compound in rat models. “In a previous study, we synthesized this compound AD732. In this study, we compared it with two standard pharmaceutical drugs—indomethacin, a prototype NSAID, and celecoxib, a COX-2 inhibitor.” explains Dr. Amagase. “We aimed to assess its efficacy and adverse effects while relieving both acute and chronic pains.”

The researchers tested AD732’s anti-inflammatory properties in rat models of paw edema and granuloma. They tested its analgesic properties in a rat model of hyperalgesia and with hot plate tests, where a rat is placed on a temperature-controlled heated plate and its responses are monitored for signs of pain. The results were encouraging. AD732 showed higher anti-inflammatory and analgesic effects than the standard agents, while showing no ulcerogenic effects and causing minimal harm to kidney function.

Further, upon in vitro investigation of its mechanism of action, the scientists found that AD732 was a less potent inhibitor of COX-2 than celecoxib, which may indicate a lower potential for cardiovascular toxicity. Their inference is premised on prior studies, where highly potent COX-2 inhibitors have been noted to cause serious cardiac damage. For instance, rofecoxib (popularly known by the brand names “Vioxx,” “Ceoxx,” and “Ceeoxx”), a selective COX-2 inhibitor, drew flak from the New England Journal of Medicine for significantly increasing the risk of heart attacks and was subsequently withdrawn from the market in 2004.

But despite being a less selective inhibitor of COX-2, AD732 had proved very therapeutically effective, as previously mentioned, particularly in inhibiting rat paw edema. This seems, to an extent, to be counterintuitive. Dr. Bekhit muses, “Our findings on AD732’s lower COX-2 inhibition could indicate that this is not the sole mechanism contributing to its anti-inflammatory actions.” Further in-depth research is needed to determine its precise mechanism of action.

Nevertheless, as Dr. Amagase explains, “It may be concluded that compound AD732 appears to be a safer and more effective molecule with promising potential for the management of pain and inflammation, even in difficult diseases such as ulcerative colitis and Crohn’s disease.”  Perhaps, soon, we will be able to kill pain without hurting our bodies.

Posted on Pain Management

An illuminated 3D tour of lower back pain

An illuminated 3D tour of lower back pain (video)

Fluorescently labeled molecules target unfurled collagen proteins to create detailed images and 3D maps of damaged soft tissues in the spines of mice and rats. Credit
American Chemical Society

Back pain affects many people at some point in their lives, and a common cause is damage to the squishy discs or flexible, rubbery tissues of the spine. However, observing this damage at an early stage is difficult with current imaging methods. Now, researchers reporting in ACS Nano can see microscopic soft tissue destruction in animal spines by targeting denatured collagen with fluorescent molecules.

Anywhere along the spine, from the neck to tail bone, can become uncomfortable when its soft and protective tissues, including the cartilage and jelly-like intervertebral discs, become damaged and lose their structure. Daily wear-and-tear, as well as some disorders, such as facet joint osteoarthritis or ankylosing spondylitis, can degrade and unfurl the collagen proteins that give these tissues their bounce and flexibility. Detecting compromised collagen early could help patients get relief before the pain becomes severe, but this is very difficult to do with existing medical technologies, such as X-rays and magnetic resonance imaging (MRI). Previously, Yang Li and colleagues developed a collagen hybridizing peptide (CHP) probe that specifically binds unfurled collagen molecules, which happens when they deteriorate and lose their ability to cushion vertebrae. So, Li, Kuibo Zhang, Hong Shan and colleagues wanted to test if CHP labeled with fluorescent tags could be used as an imaging method to identify collagen destruction in the body.

To make the peptide probe more stable in the body, the researchers modified CHP by substituting a hydroxyl group with fluorine and then attaching a fluorescent dye to it. When healthy mice and rats were injected with the fluorescent dye-labeled CHP and imaged with near-infrared fluorescence (NIRF), the team could confirm that the fluorescing molecules accumulated on the soft tissues between the vertebrae. Then the researchers removed a portion of the animals’ spines and imaged them with light sheet fluorescence microscopy. This technique produced precise 3D maps, which revealed denatured collagen. Because CHP is known to specifically target damaged collagen, the team says their imaging experiments show that even healthy animals can have a modest degree of deteriorated collagen around load-bearing joints, especially in the lower back. In additional experiments, both the NIRF images and 3D maps generated with the new method detected collagen deterioration in animal models of spinal injury before structural changes were visible in tissues on MRI scans. Finally, the researchers applied dye-labeled CHP as a stain to intervertebral disc slides from people that had undergone spinal surgeries. The fluorescence intensity of the stain rose substantially as the level of disc degeneration increased. Based on these results, the researchers say that their molecular-level technique could be developed in clinical studies for earlier diagnosis and targeted therapeutic treatments for patients with back pain.

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Pain – Recent cannabis use linked to extremes of nightly sleep duration

CBD Treats Fibromyalgia Pain

Recent cannabis use is linked to extremes of nightly sleep duration–less than 6 hours or more than 9 hours–reveals a study of a large representative sample of US adults, published online in the journal Regional Anesthesia & Pain Medicine.

This pattern was even more pronounced among heavy users–those using on 20 out of the previous 30 days, the findings show.

Cannabis use in North America continues to increase, with around 45 million adults in the USA reporting this in 2019, which is double the figure reported in the early 2000s.

This change has partly been driven by widespread decriminalisation in many states over the past decade, as well as research suggesting that cannabinoids may have therapeutic value for pain relief and possibly anxiety and sleep disorders as well, say the researchers.

Cannabis has become popular as a sleep aid, particularly as the prevalence of sleep deprivation and insomnia has increased. Only two thirds of Americans get the recommended 7-9 hours of sleep every night, and almost half report daytime sleepiness every day.

But the evidence to date on the impact of cannabis on the sleep-wake cycle has been equivocal.

The researchers wanted to see if cannabis use might be linked to nightly sleep duration in a nationally representative sample of US adults (aged 20-59) who had taken part in the biennial National Health and Nutrition Examination Survey (NHANES) for the years 2005 to 2018 inclusive.  

And they wanted to know if respondents reported difficulty falling asleep, staying asleep, or slept too much in the preceding 2 weeks; whether they had ever consulted a doctor about a sleep problem; and whether they regularly experienced daytime sleepiness on at least 5 of the preceding 30 days.

Survey respondents were characterised as recent or non-users if they had or hadn’t used cannabis in the past 30 days. Sleep duration was defined as short (less than 6 hours), optimal (6–9 hours), and long (more than 9 hours). 

Information was gathered on potentially influential factors: age; race; educational attainment; weekly working hours; a history of high blood pressure, diabetes, and coronary artery disease; weight (BMI); smoking; heavy alcohol use (4 or more drinks daily); and prescriptions for opioids, benzodiazepines, ‘Z drugs’ (approved for insomnia), barbiturates, other sedatives, and stimulants.

Some 25,348 people responded to the surveys between 2005 and 2018, but the final analysis is based on 21,729 who answered all the questions, representing an estimated 146.5 million US adults. 

The average nightly sleep duration was just short of 7 hours across the entire sample.  Some 12% reported  less than 6 hours, while 4% reported more than 9 hours a night. 

A total of 3132 (14.5%) respondents said they had used cannabis in the preceding 30 days. Recent users were more likely to report not sleeping enough or sleeping too much.

They were 34% more likely to report short sleep and 56% more likely to report long sleep than those who hadn’t used cannabis in the preceding 30 days, after accounting for potentially influential factors.

And they were also 31% more likely to report difficulty falling asleep, staying asleep, or sleeping too much in the preceding 2 weeks, and 29% more likely to have discussed a sleeping problem with a doctor. But recent cannabis use wasn’t associated with frequent daytime sleepiness.

Further analysis of the frequency of cannabis use revealed that moderate users, defined as using on fewer than 20 out of the past 30 days, were 47% more likely to sleep 9 or more hours a night compared with non-users. 

Heavy users, defined as using on 20 or more out of the preceding 30 days, were 64% more likely to experience short sleep and 76% more likely to experience long sleep compared with non-users.

These findings differed little across the survey years.

This is an observational study, and as such, can’t establish cause, or reverse causality, for that matter. 

The researchers also point to several study limitations, including the reliance on self-reported data and the lack of information on cannabis dose. The historical and the historical and ongoing stigma associated with cannabis use may also have affected the responses to questions about cannabis use, they suggest.

But they say: “Increasing prevalence of both cannabis use and sleep deprivation in the population is a potential cause for concern.

“Despite the current literature demonstrating mixed effects of cannabis and various cannabinoid formulations on sleep architecture and quality, these agents are being increasingly used as both prescribed and unprescribed experimental therapies for sleep disturbances.”

They add: “Our findings highlight the need to further characterize the sleep health of regular cannabis users in the population…Sleep-wake physiology and regulation is complex and research about related endocannabinoid pathways is in its early stages.”

Posted on Pain Management

Vitamin D and Chronic Pain by Dr. Andrea Furlan MD PhD

Vitamin D and Chronic Pain by Dr. Andrea Furlan MD PhD - YouTube


Doctor Andrea Furlan explains what Vitamin D does in the body, what are the sources to obtain Vitamin D and how much should a person take of Vitamin D supplements. She also explains that it is important not to take too much Vitamin D because it can be toxic.