Posted on Fibromyalgia, Pain Management

Manchester Digital Pain Manikin: A New Way of Measuring Pain

FROM THE MANCHESTER UNIVERSITY BLOG!

A team of researchers from the Centre for Health Informatics and the Centre for Epidemiology Versus Arthritis have developed the Manchester Digital Pain Manikin app.

The app contains a human body-shaped figure (the manikin) on which people can draw to indicate where they have pain and how severe that pain is. The Manchester Digital Pain Manikin app was developed in collaboration with uMotif, a digital health company from London.

Why we measure chronic pain?

Chronic pain is a common health problem. Estimates are that one in five adults in the UK have it, and one in ten are newly diagnosed with it every year. For some people, chronic pain is a condition on its own, while for others it is a symptom of another condition (e.g. rheumatoid arthritis).

Living with chronic pain has a negative effect on people’s physical and mental health, which makes it harder for them to do their daily activities, go to work, and socialise. But despite it being so common and having such an impact, we still do not know exactly how many people have chronic pain, what causes it, and how best to treat it.

To fill these gaps in our knowledge, researchers need better ways to measure pain, so that they can collect high quality data for their studies.

Pain is subjective and can only be measured by asking the person who is experiencing it. The most common way for people to self-report pain in research studies is through questionnaires. But questionnaires may not be the best way to capture people’s pain. For example, if people have different levels of pain in different areas of their body, or if they struggle to complete questionnaires because of language barriers.

What is the Manchester Digital Pain Manikin and why is it better?

The Manchester Digital Pain Manikin app has a human body-shaped figure (the manikin) on which you can indicate where you have pain and how severe the pain is in each location. You can do this by drawing directly on the screen of your smartphone using your finger. The app is currently only available for Android phones.

The Manchester Digital Pain Manikin is a more intuitive way for people to self-report the location of their pain compared to questionnaires. We expect that this will make it easier for people to report their pain over longer periods of time. And because the app is connected to a database at the University of Manchester, pain reports can be sent to the research team for analysis automatically and without delay.

Testing the feasibility of the Manchester Digital Pain Manikin

We previously developed a prototype of the Manchester Digital Pain Manikin app that we tested with 15 people, who all found it feasible to use. However, we only asked them to complete a manikin report once. Also, they were all white British, while we know that pain is especially common among black and Asian people.

That is why we are currently doing a study that will test the feasibility of using an improved version of the Manchester Digital Pain Manikin app in a bigger and more diverse group of people. We aim to recruit a total of 108 people with rheumatoid arthritis, osteoarthritis or fibromyalgia, with half of them being non-white. And instead of only once, we ask them to submit a manikin report on their own smartphone every day for 30 days.

In the video below, Dr Sabine van der Veer further explains the purpose of the feasibility study. If you are interested in taking part, please contact the research team by sending an email to painmanikin@manchester.ac.uk. The study will run until the end of September 2021.

Next steps

Once we know that people find the Manchester Digital Pain Manikin a feasible way of measuring pain, we will evaluate in a next study whether it is also a reliable and valid way that has the ability to detect a change in pain. The results of this next study will show whether our manikin is suitable for, for example, monitoring if a person’s pain is progressing over time, or for assessing if a new drug or therapy provides pain relief.

In the longer term, we hope that the Manchester Digital Pain Manikin will become a widely accepted way of collecting high quality, self-reported pain data in large, representative groups of people in the UK and other countries. This will enhance our knowledge on chronic pain and how to treat it.

Posted on Mental health

Tips to help tackle post-pandemic mental health problems

Dr Juliet Anton
Dr Juliet Anton

Dr Juliet Anton, Chartered Psychologist and founder of new self-help app, AskDoc, offers insights and techniques to help manage your own mental health following the impact of the pandemic 

After 18 months of unprecedented events, periods of isolation and overall health challenges due to the coronavirus pandemic, it is unsurprising that so many people have struggled with their mental health and wellbeing.  

In fact, new studies have revealed that the fear of transmitting COVID-19 has led to an increase in psychological symptoms, such as low mood, confusion, stress, and anxiety among individuals who have never previously experienced mental illness

In addition, 63% of Brits are revealed to be facing mental issues amid the pandemic, meaning there is a greater need for the nation to understand and manage their mental health on their own terms. 

Dr Juliet Anton, Chartered Psychologist and Founder of new self-help app, AskDoc, shares her insights for those struggling with mental health difficulties and provides some top tips on how to understand and manage your mental health, as well as, recognise when further assessment and/or specialised support is required. 

  1. Recognise the symptoms.

Keep a mood diary to help you recognise how your mood is affected on a day-to-day basis. Whether you’re feeling increasingly agitated, emotional, nervous, restless, or even lonely and isolated from others, these can all impact your mental wellbeing and shouldn’t be ignored. Self-help apps can be a great way of identifying these symptoms.


 

  1. Be kind to yourself. 

Our inner voice can sometimes be quite cruel, as we tell ourselves we should be stronger or less emotional in certain situations – but we wouldn’t speak like this to our loved ones, so why do we say things like this to ourselves? Learning to be kinder to yourself is essential for those struggling with mental health as you can then work on lifting yourself up instead of putting yourself down. 

  1. Open up to someone you trust.

Even though you may feel it sometimes, you are not a burden to your loved ones and your feelings are valid. Make sure to reach out to your support system when you’re feeling low, whether a friend, your mum or even a mental health professional. Sometimes when our mental health falters we can feel like we are bothering people with our problems – if this is the case for you, there are many ways to manage your mental health including self-help apps where you can manage your mental health on your own terms. Alternatively, you can speak to a medical professional or GP if you don’t feel you can speak to your loved ones – so it’s important to remember that you always have someone there to help you.  

  1. Use cognitive behavioural therapy. 

Much like the rest of our body, when our brain is suffering, you need to seek help from a qualified professional. The AskDoc app aims to normalise seeking help even when you haven’t considered it in the past, using cognitive behavioural therapy (CBT) to help you on your journey. CBT encourages you to talk about your difficulties in terms of thoughts, feelings, and behaviours. People often assume their mental health problems aren’t bad enough to seek help, but its better to face them head on rather than to let them build up until you reach the end of your tether. 

  1. Feelings won’t last forever.

When feeling sad or low, we often think it’s going to stay with us forever, but there is a reason we call them mood swings. Low moods rarely last forever and when you can feel a dark cloud coming over, it’s important to remember that by speaking to others, sharing your emotions and taking some time to relax, these things will help to lift your mood. It’s important to be patient with yourself and use the support systems around you.

And there you have it, five tips and techniques to help you understand and improve your mental health. Remember you’re not alone and it’s important to open up and speak to the people you trust who may be able to help you.   

Posted on Diabetes

People of normal weight with type 2 diabetes can achieve remission by losing weight

New research presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, found that contrary to the perceived wisdom, people of normal weight with type 2 diabetes (T2D) can reverse the condition through substantial weight loss.

Eight of the 12 participants achieved remission after losing 10-15% of their body weight, despite having a BMI that fell in the normal weight range.  Levels of fat in the liver and pancreas fell substantially and the activity of the insulin-producing cells in the pancreas was restored.

The finding clearly demonstrates weight loss can be beneficial in type 2 diabetes, even in those who are of normal weight, says Professor Roy Taylor, of Newcastle University, Newcastle, UK, the principal investigator on the trial.

It also supports the idea that we each have a “personal fat threshold” – a level of body fat we can cope with – and if we go above it, we will develop T2D, even if we are still of normal weight.

Professor Taylor explains: “Our previous research has shown that weight loss of 10-15% can achieve remission in people with type 2 diabetes who are overweight or obese.

“Doctors tend to assume, however, that type 2 diabetes has a different cause in those who aren’t overweight.  This means that, unlike those who are overweight, those who are of normal weight aren’t usually advised to lose weight before being given diabetes drugs and insulin.

“Instead, there’s a tendency to start them on insulin and other medication at a much earlier stage.

“What we’ve shown is that if those of normal weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.

“This should be a wake-up call to doctors and, with one in ten of the 4.5 million people with type 2 diabetes in the UK of normal weight at diagnosis, there is no time to be lost in getting the message across.”

Affecting one in 11 of the world’s adult population (415 million people), and on the rise, T2D occurs when the pancreas can’t make enough insulin (a hormone which helps turn the sugar in food into energy) or the insulin it makes doesn’t work properly.

Previously, the landmark Diabetes Remission Clinical Trial (DiRECT), from Glasgow and Newcastle universities, showed that an intensive weight loss programme delivered by GPs can put T2D into remission in people who are overweight.

The latest results are from the Reversal of Type 2 Diabetes upon Normalisation of Energy Intake in the Non-obese (ReTUNE) trial, which is looking at whether weight loss can also reverse the condition in people of normal weight.

Twelve men and women who had T2D and were of normal weight (average BMI of 24.5) followed a weight loss programme in which they consumed 800 calories a day (from low calorie soups and shakes) for two weeks, followed by four to six weeks in which they received support to maintain their new weight. They completed up to three rounds of this diet/weight maintenance cycle until they had lost 10-15% of their body weight.

The participants underwent a range of tests at the start of the study and after each round of dieting and weight maintenance.  Their results at the end of the study were compared to those of a group of controls – people without diabetes who were matched for age, sex and BMI.

Average weight fell by 8.2kg, from 69kg to 61.8kg – a reduction of 11.9%. Total body fat fell from 33.1% to 27.4%. This compares to a figure of 25.4% for the controls.

Scans showed that the average amount of fat in the liver fell from 4.4% – more than twice as high as in the controls – to 1.4%.

Fat in the pancreas fell from an average of 5.1% to 4.5%. Average levels of triglycerides (plasma TG, a measure of fat metabolism efficiency) fell dramatically from 1.6mmol/L to 1.0mmol/L – on a par with the controls.

In eight of the 12 participants (67%), diabetes went into remission, a similar proportion to previous studies involving overweight and obese participants. Remission was defined as HbA1c (average blood sugar level) of less than 48mmol/mol and off all medication.

Professor Taylor says: “These results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by being too heavy for your own body.  It’s due to having too much fat in your liver and pancreas, whatever your BMI.

“In the liver, this excess fat prevents insulin from working normally.  In the pancreas, it causes the beta cells to stop producing insulin.

Dr Ahmad Al-Mrabeh, the study’s first author and co-investigator, who has recently moved from Newcastle University to the University of Edinburgh, adds: “We’ve already shown a process called hepatic lipoprotein export to be key.  

“Lipoproteins are substances made of protein and fat which export fat through the bloodstream. Excess fat is normally stored in the subcutaneous fat areas under our skin. However, when the stores are filled up, or became dysfunctional, excess fat will spill over into the bloodstream before being stored in the liver and exported by lipoproteins to other tissues. 

“We’ve demonstrated that this process is the driver of the fat build-up in the pancreas believed to damage the insulin-producing cells and cause type 2 diabetes.

“Weight loss by calorie restriction is powerful in achieving remission of type 2 diabetes and it is remarkable to have 67% remission in this non-obese group.

“However, this approach is challenging for many people including those with normal BMI. Our team here in Edinburgh is exploring the exact mechanisms that lead to remission during weight loss, which we believe will inform prevention, as well as the design of more targeted novel therapies both in addition to and as alternatives to calorie restriction.”

Professor Taylor adds: “As a rule of thumb, your waist size should be the same now as when you were 21.  If you can’t get into the same size trousers now, you are carrying too much fat and therefore at risk of developing type 2 diabetes, even if you aren’t overweight.”

Posted on Autism

Number diagnosed with autism jumps 787% in two decades, study shows

Autism prevalence
Autism prevalence

The number of people diagnosed with autism has jumped by 787 per cent in the past two decades, a new study shows, likely an effect of increasing recognition.

The exponential increase – between 1998 and 2018 – was greater for females than males, with the greatest rises among adults.

Researchers compared the rates of autism recorded in GP records in England, covering over 9 million patients from GP practices.

The study, published in the Journal of Child Psychology and Psychiatry, suggests the diagnosis of Asperger’s disorder, a form of autism that does not have attendant intellectual disability, was increasingly applied until the diagnosis was officially scrapped in 2013.

The research suggests increases could be due to increased reporting and application of diagnosis. This is the first study to analyse the time trend of autism diagnosis in a population-based UK clinical cohort by developmental stage, level of severity and by gender, over a twenty-year period.

Differing rates of increase between subgroups suggest effects are primarily due to increased recognition, although an actual increase in autism incidence cannot be ruled out.

A UK policy introduced in 2009 to invest in adult assessment centre may underpin the rise in adult diagnosis.

“As there is not really a plausible reason why autism should increase more in adults and females our study suggests the change is probably due to increased identification, and not more people with neurodevelopmental disorders per se.” said lead author Ginny Russell, from the University of Exeter.

“However, autism is not like a continent awaiting discovery. The definition of what constitutes autism has changed over time, and females and adults were not often thought of as having autism 20 years ago. The vocal work of charities and media coverage, combined with changes in policy has led to more assessment centres for adults, and an autism narrative that many women and girls identify with.  Consequently demand for diagnosis has never been higher.”

Data was taken from the Clinical Practice Research Datalink (CPRD) primary care database, which contains patients registered with practices contributing data to the CPRD between 1998 and 2018. A total of 65,665 patients had a diagnosis of autism recorded in 2018.

The findings also highlighted increased age of diagnosis over time within each developmental stage. In preschools this could be partly because diagnosis of autism in younger children is obviously complex and may need to go at the family’s pace. De-stigmatization of the label due to work by the neurodiversity movement and parent-led lobby groups may have contributed to rising demand for diagnosis in order to access support, outstripping the capacity to carry out assessments in clinical practice.

Autism is popularly conceptualized as a ‘male’ disorder. In response there has been a drive toward referral of more females. The study, which shows a marked growth in female diagnoses compared with males, suggest such initiatives have been having an effect.

The research was conducted by Ginny Russell, Sal Stapley, Tamsin Newlove-Delgado, Andrew Salmon, Fiona Warren and Anita Pearson from the University of Exeter, Tamsin Ford from the University of Cambridge and Rhianna White from the University of Bath.