Roger B. FiLLiNGiM PhD
Colleen M. FiTZGERALD MD, MS
Michael R. CLARK MD, MPH, MBA
A prominent psychiatrist and pain educator discusses the challenge of managing patients with chronic pain who also suffer with borderline personality disorder and depression, including the special difficulties associated with demanding, noncompliant, and high-utilizer patients. Dr. Clark is Vice Chair of Clinical Affairs, Johns Hopkins University School of Medicine, the Director of the Adolf Meyer […]
John J. BURKE
- Emerging Mosquito-Borne Virus Mimics RA Symptoms
Researchers at Washington University School of Medicine in St. Louis report that a mosquito-borne virus now present in the Caribbean and Central and South America and which has caused isolated infections in Florida often causes joint pain and swelling similar to that seen in patients with rheumatoid arthritis (RA). Misdiagnosis of the viral infection may also be occurring, since blood tests of patients with the Chikungunya virus and those with RA can produce similar results. The findings are reported in the January issue of Arthritis and Rheumatology. The global spread of the Chikungunya virus suggests that the disease is likely to be a diagnostic challenge in the years ahead. RA is typically treated with drugs that suppress the immune system, but it’s not yet known whether that approach will help or harm patients with Chikungunya virus. It is therefore important that clinicians obtain detailed travel and medical histories from patients being evaluated for RA. This information could help distinguish between the 2 conditions. Read a news story about the findings and recommendations here.
- Back Pain: Device Encourages Patient Participation via “Gamified” Physical Therapy
Swiss-based medical technology company Hocoma has introduced a new wearable device for the management and control of chronic lower back pain. The Valedo is a pair of sensors that attach to the user’s skin using medical grade double-sided tape: 1 at the small of the back, 1 on the upper chest. The 2 sensors connect to the Valedo app on an iOS device via Bluetooth 4.0 that provide the wearer with up to 45 different exercise routines designed to emulate those that would be performed in physical therapy for back pain relief. Valedo has been FDA approved for use in the US and is also available in several European countries. The device presently retails for $359. The gamified exercise approach is designed to encourage patient compliance with therapy, to maximize recovery from pain and strengthen the back to forestall to onset of additional pain events. Read more about the device in these 2 news stories, covering the product introduction earlier this month at 2015 International CES in Las Vegas, here, and a user review published this week in the technology newsletter re/code, here.
- Studies Needed: Arthritis/
Musculoskeletal Pain Reduction
An analysis of available studies suggests that platelet-rich plasma (PRP) therapy for knee, elbow, and tendon injuries produced better, long-lasting improvements than surgical or steroid treatments for some patients. The findings are published in The Journal of the American Osteopathic Association (JAOA). Statistically significant improvements were also observed in patients with knee pain caused by osteoarthritis as well as those suffering from other musculoskeletal disorders involving knees, elbows, and tendons. PRP is considered a controversial therapy, in part because only a few small clinical trials have been conducted. The study, conducted by researchers from the Department of Physical Medicine and Rehabilitation at the University of Miami Miller School of Medicine, analyzed those trials and found PRP, a form of regenerative medicine, reduced pain and improved function better than steroid treatment over longer periods of time. In some trials reviewed, patients showed sustained improvements at 1 and 2 years post-treatment. A news release on the findings, with link to the journal article, may be read here.
- Cytokines Regulate Neuropathic Pain in the Young
Results of an animal study published this month in the Journal of Neuroscience found that anti-inflammatory molecules act to prevent the development of pain from nerve injury in young, but not adult, rodents. The findings suggest the presence of a mechanism that may protect young people from developing neuropathic pain. The researchers theorize that an anti-inflammatory response may prevail in the young to protect the developing nervous system from attack by the immune system. In the study, induced nerve injury raised levels of anti-inflammatory molecules, including the cytokines interleukin-4 (IL-4) and IL-10, in the spinal cord. Blocking IL-10 in the young unmasked hypersensitivity to touch due to the nerve injury. Clinicians have observed that nerve injuries early in life rarely lead to neuropathic pain syndromes in childhood, unlike injuries suffered in adulthood. The new study suggests that a comparable anti-inflammatory response to injury in children may spare them from developing the hypersensitivities associated with neuropathic pain. Read a news story on the findings, with link to the journal article, here.
Department of Public Health and Community Medicine
Tufts Medical Center