Chronic Back Pain Experience Originates in the Brain
The vast majority of adults have had a sore back at some point in their lives. If they're lucky, the pain subsides after a few days or weeks. But for some, whose initial injuries appear no different than the fortunate ones, back pain lasts for years. Now, researchers have discovered a difference in brain scans between the two groups of patients that appears early in the course of the pain.
"This is the very first time we can say that if we have two subjects who have the same type of injury for the same amount of time, we can predict who will become a chronic pain patient versus who will not," says neuroscientist Vania Apkarian of Northwestern University, Chicago, who led the new work.
Over the past 2 decades, Apkarian's lab has run many studies comparing the brains of patients with chronic back pain with those of healthy people, finding differences in brain anatomy or the function of certain regions. But the study designs made it hard to sort out which brain changes were consequences of the chronic pain—or the patients' painkillers or altered lifestyles—versus those that drove the pain's chronic nature.
Apkarian and colleagues have now tracked the brains of back pain patients over time rather than comparing single neural snapshots. His team began with 39 people who had experienced moderate back pain—a five or six on a self-described scale of 10—for 1 to 4 months. Over the next year, the team scanned the patients' brains four times and followed their pain. By year's end, 20 of the patients had recovered, while 19 continued to hurt, meeting the criteria for chronic pain.
The scientists then looked at a number of brain characteristics, including the amount of communication between two areas of the brain previously seen to have altered activity in back pain patients: the insula and the nucleus accumbens. These regions are involved in emotional responses to a person's environment and in how the brain learns. Not only did they measure more communication between the two areas in chronic back pain patients than in those whose pain subsided, but the increased crosstalk could be seen as far back as the start of the study, suggesting that it could have predicted which patients would suffer the whole year. But further work will need to confirm that the scans have predictive value.
The results, published in Nature Neuroscience, could be used to pinpoint patients who are at the highest risk for chronic pain , says Apkarian. "Our interpretation of the results is that how these areas of the brain engage with the injury then dictates how the rest of the brain is going to reorganize," says Apkarian. It underscores that brain regions involved in learning and emotions are important in the development of chronic pain, he says, not just brain regions directly responsible for sensing pain.
Massage Right After Muscle Injury May Boost Healing
Massage is known to help heal muscle injury, but the degree of recovery may depend on certain factors, such as the timing of the treatment, according to the results of a study in rabbits. A research from The Ohio State University Wexner Medical Center confirms for the first time the measurable effects of massage-like pressure on the recovery of muscle fiber damage.
The findings could one day lead to specific prescriptions for massage to help exercise-induced muscle injury in athletes, the researchers saID.
Knowing that massage therapy can ease muscle pain and weakness associated with exercise, the researchers studied 24 white rabbits to determine the massage pressure, duration and timing needed to improve healing following a muscle injury. In conducting the animal study, the researchers used a mechanical device that mimics movements associated with exercise and a second device that mimics a massaging motion. They compared different frequency, pressure and duration tests to determine their effect on muscle.
"We have translated what we thought was going on in humans, largely based on self-reporting, into the laboratory and designed the instrumentation to apply controllable and measurable forces," Dr. Thomas Best, co-director of OSU Sports Medicine, said in a university news release.
"We found if damaged muscle is massaged right away -- for 15 minutes -- there is a 20 to 40 percent chance of recovery. Initial injury in the animal model was extended if massage did not take place within 24 hours," While the findings hold promise, experts note that research involving animals frequently fails to lead to benefits for humans. The study authors said their findings provide potential guidelines for future clinical trials.
"We're excited about the clinical implications of this research," said Best. "After testing in humans, we'll potentially be able to prescribe specifics for massage to help exercise-induced muscle injury in athletes."
Researchers have long been aware that the progressive loss of muscle mass and bone density is a natural part of aging. But little work has investigated how muscle tissue affects the inner and outer layers of bone microstructure. A Mayo Clinic study looked at skeletal muscle mass and bone health across the life span and discovered distinct differences in how muscle affects the two layers of bone in men and women.
The findings are published in the Journal of Bone & Mineral Research. "Our study adds to the growing body of evidence supporting the highly integrated nature of skeletal muscle and bone, and it also provides new insights into potential biomarkers that reflect the health of the musculoskeletal system," says lead author Nathan LeBrasseur, Ph.D., of the Department of Physical Medicine and Rehabilitation and the Robert and Arlene Kogod Center on Aging at Mayo Clinic.
Researchers reviewed records from a long-standing Mayo Clinic study of bone health involving 272 women and 317 men ages 20 to 97. They examined the association of skeletal muscle mass (relative to participants' height) with bone architecture and strength, using several high-resolution imaging technologies that distinguish the outer cortical layer of bone from the inner trabecular layer. The study found that muscle mass is associated with bone strength at particular places in the body. In women, muscle mass was strongly connected to cortical health at load-bearing locations such as the hip, lumbar spine and tibia.
Researchers also found that muscle mass was associated with the microarchitecture of trabecular bone in women's forearms, a non-load-bearing site, at higher risk of fracture following menopause. The higher the level of the circulating protein, IGFBP-2, the lower relative muscle mass overall, they discovered. "We found IGFBP-2, which has already been linked to osteoporotic fractures in men, is a negative biomarker of muscle mass in both sexes," Dr. LeBrasseur says. "This finding could potentially be used to determine people who are at a particular risk for falls and associated fractures." The subject of muscle and bone health is vital, especially for the elderly. Weakened muscle can lead to bone-breaking accidents that result in loss of independence and even death.
Study suggests touch therapy helps reduce pain, nausea in cancer patients
A new study by the University of Kentucky Markey Cancer Center shows that patients reported significant improvement in side effects of cancer treatment following just one Jin Shin Jyutsu session. Jin Shin Jyutsu is an ancient form of touch therapy similar to acupuncture in philosophy.
Presented at the 2012 Markey Cancer Center Research Day by Jennifer Bradley who is the Jin Shin Jyutsu integrative practitioner at Markey, the study included 159 current cancer patients. Before and after each Jin Shin Jyutsu session, Bradley asked patients to assess their symptoms of pain, stress and nausea on a scale of 0-10, with 0 representing no symptoms.
The study found that in each session patients experienced significant improvement in the areas of pain, stress, and nausea with the first visit and in subsequent visits as well. The mean decreases experienced were three points for stress and two points for both pain and nausea.
"I was pleased to see quantitatively the improvements that patients noted in these primary areas of discomfort," said Bradley. "It was interesting to note that regardless of age, sex or diagnosis, cancer patients received a statistically significant improvement in the side effects from treatment. It is encouraging to note that Jin Shin Jyutsu made improvements in these areas without adding additional unwanted effects that so often occur with medication interventions."
Funded by a grant from the Lexington Cancer Foundation, Jin Shin Jyutsu is considered part of an integrative treatment plan available at the UK Markey Cancer Center. Bradley offers Jin Shin Jyutsu to all cancer patients at no charge. Patients may self-refer, though half are referred by their physician or Markey staff.
During a Jin Shin Jyutsu session, patients receive light touches on 52 specific energetic points called Safety Energy Locks as well as fingers, toes, and midpoints on the upper arm, upper calf and lower leg in predetermined orders known as "flows." Patients remained clothed except for shoes and all hand placements are done over clothing.
Sessions were performed in the Jin Shin Jyutsu Treatment Room, Chemotherapy Outpatient Clinic, or in the patient's hospital room. The study also noted that the greatest overall improvement came from sessions held in the Jin Shin Jyutsu Treatment Room, where sessions are generally of a longer duration.
The study did not include controls for several parameters including the time between sessions or location and duration of service. Bradley's next study will control more of these variables, and her team will access patients' medical records over the time period of their participation to evaluate changes in patients' medication usage for cancer and symptom management of pain, stress and nausea.
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