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The U.S. workforce participation rate (those employed or unemployed and seeking work) is declining – which could mean major economic and social issues for the country in the coming years – and pain has been cited as a major contributing factor. That’s according to as new paper by Princeton University labor economist Alan Krueger, which was released this week in advance of its presentation at the Federal Reserve Bank of Boston conference this weekend. This paper, titled “Where Have All the Workers Gone?,”[1] paints a distressing picture of the future of the American workforce – one in which pain plays a prominent part.

The Workforce Problem

As is well-known to both economists and the general population alike, in the near future the country is going to see a major shift in the workforce population (those who are employed or unemployed and looking for a job), mainly due to the retirement of the Baby Boomer generation. This shift is in addition to a larger number of young adults delaying their entry into the workforce (due to more entering higher education), a declining number of women entering the workforce (many  still choosing to stay at home) and, most importantly, an increasing number of “prime age” men (ages 25-64) who aren’t in the workforce at all (unemployed and not seeking employment).

All of these changes have led to a significant decline in workforce participation, one that’s been worsening since 2007. And it’s a trend that, according to Krueger, isn’t going to abate without major societal changes. So the question remains: Why aren’t many of these prime age men, who were once considered the main breadwinners of the family, able to participate in the workforce?

The Prime Age Problem

The U.S. is not alone in seeing a decline of this valuable group of workers. In fact, “the participation rate of prime age men has trended down in the U.S. and other economically advanced countries for many decades.” But, compared to other advanced countries, the U.S. has seen one of the worst declines – surpassed only by Italy. The main reason, Krueger concludes, is health-related problems – especially pain.

Of those prime age men who are out of the labor force, 43% report their health as fair or poor, with 34% of them reporting at least one disability (like difficulty walking or climbing stairs). “As a group,” the paper states, “workers who are out of the labor force report feeling pain during about half of their time.” These men experience both a greater prevalence and greater intensity of pain in their day-to-day lives than employed and unemployed men. Because of that, somewhere between 44%-47% are on pain medication (including OTC), with 2/3 of those men utilizing prescription painkillers.

This pain is a clear factor keeping them from work. In fact, 40% of these prime age men responded “yes” when asked directly if pain prevented them from working a full-time job for which they were qualified.

The Mental Health Problem

This inability to join the workforce takes its toll on prime age men. By looking at various studies, Krueger found that men outside the workforce were less happy, sadder and more stressed than even unemployed men were.

In comparison, women outside the workforce report more happiness and less stress, meaning that – unlike their male counterparts – they’re deriving considerable meaning from their activities. This points to an urge amount the prime age men to return to the workforce; but with high levels of pain, that’s a difficult feat.

The Solution

Krueger concludes that stemming this tide of prime men leaving the workforce should be an issue of national priority. But how can this be done? Krueger takes a stab at answering that, as well. “The finding that nearly half of [these] prime age men take pain medication on a daily basis and that 40% report that pain prevents them from accepting a job suggests that pain interventions could potentially be helpful,” he says.

Intervening to both wean these men off of medications that could be dangerous to their health and future ability to work and reducing their pain levels to the point where they can return to the workforce would go a long way toward reversing this dangerous trend. Many pain management organizations, like Advanced Pain Management, are working toward these ends, utilizing the latest interventional technologies.

This advancement, along with other cultural and national shifts – like increased access to healthcare and equal pay and advancement for women – may help stem the tide of workforce decline, ensuring this country doesn’t face further inequality and division in the coming years.

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[1] Krueger, Alan. “Where Have All the Workers Gone?” October 04, 2016. Accessed October 10, 2016.

Additional information: Coy, Peter. “Why Are so Many Men Not Working? They’re in Pain.” Bloomberg Businessweek. October 7, 2016. Accessed October 10, 2016. http://www.bloomberg.com/news/articles/2016-10-07/why-are-so-many-men-not-working-they-re-in-pain.

Published in Work

The placebo effect is well-known, especially when it comes to clinical trials. Conventionally, patients receive a placebo believing they are getting an active medication and afterward report improved symptoms. But the ethical problem of giving patients a placebo without their knowledge has impeded its use as a treatment method. Until now, that is. A new study[1] has found that patients who knowingly take a placebo for the treatment of chronic low back pain see improvements in both pain and function – which could lead to another avenue of treatment for those battling chronic pain.

Study Overview

The study, titled “Open-Label Placebo Treatment in Chronic Low Back Pain,” was published in the December issue of PAIN, the official journal of the International Association for the Study of Pain.

The authors selected 97 patients (83 of whom completed the trial) with chronic low back pain, who were then examined by a nurse and board certified pain specialist before receiving a brief overview of the placebo effect. The majority of these patients were already undergoing some kind of treatment for their pain, mostly NSAIDs. (Patients taking opioids were not included in the study.)

Some of the patients were instructed to continue with their treatment as usual, while the others were told to add a placebo pill (in a bottle clearly labeled “Placebo”) twice daily to their existing regime. They were instructed not to make any other lifestyle or medication changes during the study. Both groups spent three weeks doing their respective treatments, while monitoring their average, minimum and maximum pain levels, as well as their level of disability. At the end of the trial, the group that did not take placebo was also given the chance to incorporate it into their treatment for three weeks.

Key Findings

At the end of the three weeks, both groups of patients were brought in for an interview, during which they rated their maximum, minimum and usual pain, as well as their back-related dysfunction. Those in the placebo group experienced a 30% reduction in both usual and maximum pain, while those in the normal treatment group only experienced a 9% reduction in usual pain and a 16% reduction in maximum pain.

Similarly, the placebo group saw a 29% drop in pain-related disability, while those in the normal treatment group saw almost no improvement.[2] These results were seen despite the fact that 70% of the placebo group was initially either skeptical of the placebo or didn’t believe it would have much of an effect.

After the normal treatment group was allowed to utilize placebos for three weeks, they also saw significant pain relief (a 29% decrease in maximum pain and a 46% decrease in minimum pain) and an improvement in back-related disability (which decreased by 40%).

Implications for the Future

It’s not entirely clear why placebos produced such staggering pain relief, but the researchers did put forth several theories. The success could be due, in part, to the positive way placebos were introduced to the group. Presenting the experiment to participants in a positive manner – for instance, as a “novel mind-body clinical” option – may have helped curate hope in the participants. For chronic pain patients who often feel hopeless in the face of ineffective treatment options, this may have been enough to convince them to suspend their disbelief, the researchers hypothesize.

The effects could also be attributed to the physical process of taking a pill. Several other studies have recently shown that the ritual aspects related to pill-taking – like opening the bottle and swallowing – may be linked to positive placebo responses.

No matter the reason, what is clear is that many patients currently suffering from chronic low back pain – and possibly other chronic conditions, as well – might benefit from adding a placebo to their treatment plan. While further studies are necessary to determine how best to utilize this new information on the placebo effect  and how it might relate to longer-term relief, these findings do suggest that placebos may eventually become an important component of treatment, reducing the need for other (possibly harmful) types of drugs.

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[1] Carvalho, Cláudia, Joaquim Machado Caetano, Lidia Cunha, Paula Rebouta, Ted J. Kaptchuk, and Irving Kirsch. “Open-Label Placebo Treatment in Chronic Low Back Pain.” PAIN 157, no. 12 (December 2016): 2766–72.

[2] “Study Finds Knowingly Taking Placebo Pills Eases Pain.” October 14, 2016. Accessed November 11, 2016. http://www.bidmc.org/News/PRLandingPage/2016/October/Kaptchuk-placebo-effect.aspx.

Published in Scientific-Research

The search for new pain-fighting drugs has been a difficult one. For the past 20 years, drug after drug has failed in the clinical trial stage, unsuccessfully addressing the pain they were created to relieve.[1] But a new study released this month may have found the key. It’s called Substance P – and it could mean better pain control in the coming years.

Study Overview

The study, published August 1 in the journal Antioxidants and Redox Signaling, was put together by researchers from China’s Hebei Medical University and the UK’s University of Leeds.[2] The study particularly looked at how this substance – neuropeptide Substance P – acted within nerve cells in lab and animal models.

Substance P is released by your body in response to “noxious stimuli,” or stressors. Although it has already been established that Substance P has “excitatory effects” on the central nervous system, this study sought to better determine its effects on the peripheral nervous system.

The study focused solely on acute pain, but lead researcher, Dr. Nikita Gamper from the University of Leeds, also plans to look at Substance P’s role in chronic pain. This research was sponsored by the UK’s Medical Research Council and China’s National Basic Research Program and National Natural Science Foundation.[1]

Important Findings

The researchers found that Substance P has the opposite effect on the peripheral nervous system than it does on the central nervous system. While in the central nervous system it excites neurons and promotes pain, it can actually work in the peripheral nervous system to make cells less responsive and excitable, thereby decreasing pain sensations. This is what they called the “pain paradox.” While it promotes pain in one area of the nervous system, Substance P acts as a natural painkiller in another.

This explains why many of the drugs created to fight pain ended up failing in clinical trials. Their intent was to suppress Substance P, but in doing so they suppressed it in both the central and peripheral nervous systems. They thus stopped Substance P from acting as a painkiller in the peripheral nervous system, where it would normally influence certain proteins that control the ability of pain-sensing neurons to respond to noxious stimuli.[1]

Implications for the Future

The researchers concluded that this study helps create a better understanding of how the body naturally fights pain. This, in turn, could lead to new drugs, potentially without the negative side effects of current prescription painkillers.[1]

As Dr. Gamper stated in a release regarding the study,1 “If we could develop a drug to mimic the mechanism that Substance P uses, and ensured it couldn’t pass the blood brain barrier into the central nervous system, so was only active within the peripheral nervous system, it’s likely it could suppress pain with limited side effects.”

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[1] " 'Pain Paradox' Discovery Provides Route to New Pain Control Drugs." ScienceDaily.com. July 28, 2016. Accessed August 12, 2016. https://www.sciencedaily.com/releases/2016/07/160728105608.htm

[2] Huang, Dongyang, Sha Huang, Haixia Gao, Yani Liu, Jinlong Qi, Pingping Chen, Caixue Wang, Jason L. Scragg, Alexander Vakurov, Chris Peers, Xiaona Du, Hailin Zhang, and Nikita Gamper. "Redox-Dependent Modulation of T-Type Ca2 Channels in Sensory Neurons Contributes to Acute Anti-Nociceptive Effect of Substance P." Antioxidants & Redox Signaling 25, no. 5 (August 1, 2016): 233-51.

Published in Scientific-Research
Wednesday, 01 November 2017 04:11

Early Adult Sleep Issues May Predict Pain Levels

It’s well known that pain and sleep are interconnected. Pain is associated with worsened sleep and lack of adequate sleep is associated with increased pain. But, according to a new study, it’s possible that for young adults, sleep problems may actually predict the onset or continuance of chronic pain.

Overview of Research

The study, titled “Sleep Problems and Pain: A Longitudinal Cohort Study in Emerging Adults,” was published in the journal PAIN, the official publication of the International Association for the Study of Pain. The researchers followed more than 1,750 men and women for three years. Their ages ranged from 19 to 22.

Emerging adulthood – a period typically defined as between 18-25 years old – is a period of both psychosocial and behavioral fluctuations, which include altered sleep patterns. In fact, around 30% of individuals in this age group experience at least one sleep problem (including needing sleeping pills, waking up hours early or not being able to fall asleep, among others). And while there have been studies showing the correlation between sleep problems and pain levels in adults, how these two factors correlate during emerging adulthood is less well known.

Study Findings

Researchers determined that sleep problems were clearly associated with chronic pain, musculoskeletal pain, headache and abdominal pain severity among young adults. Plus, sleep problems at the beginning of the study significantly increased the likelihood that participants would have new or persistent chronic pain three years later. Overall, 38% of those who had sleep problems at the study onset had chronic pain at follow-up. Only 14% of those without sleep problems exhibited chronic pain three years later. This relationship was seen more in women than in men.

The researchers also concluded that pain had a much smaller effect on sleep, with only abdominal pain sufferers reporting statistically significant sleep problems three years later. All of these findings mirror those in separate studies on both adolescents and middle-aged adults, meaning that sleep problems seem to predict pain – not just act as a precursor to it – regardless of age.

It was also found that depression, anxiety and a lack of physical activity were not significant factors in these relationships, although fatigue did play a part.

Implications for the Future

This research provides an important avenue for the treatment and prevention of chronic pain. By identifying at-risk young adults early – and by addressing their sleep problems before the onset or worsening of pain symptoms – we may be able to reduce future pain problems in some emerging adults, especially in women.  

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Published in Sleep-and-Pain

The idea of utilizing stem cells to repair and restore the human body has been a subject of public attention since the early 1990s.[1] However, most of this attention has been focused on diseases like Alzheimer’s, Parkinson’s and heart disease – not on the far more common condition of chronic pain. But that’s beginning to change, and researchers are discovering the exciting possibilities that stem cells could offer for the treatment of various pain conditions – especially back pain.

An Introduction to Stem Cells

Stem cells, in a word, are “undifferentiated.” That means that unlike other cells in the body, they have the potential to develop into a wide variety of other cells. They also carry with them the ability to repair and restore internal systems. So, in theory, it’s possible for stem cells to help repair tissues, muscles, blood, bones and organs, aiding growth and possibly even replacing missing pieces.[1]

Stem cells can be gathered from several locations, including but not limited to bone marrow and adipose (or fat). When it comes to pain management, the most studied and most well-suited type appears to be that gathered from stem cell-rich bone marrow. For the purposes of pain management, these bone marrow cells are most commonly collected from the back of the hip.[2] Once they’re collected, they may be conditioned in various ways, like centrifuging, which make the stem cells as potent as possible. They’re then injected at the site of the issue, with the hope of helping the affected tissue or system regenerate itself.

One of the main concerns of utilizing stem cells – and therefore one of the main areas of concentration in scientific studies – is the safety, specifically regarding abnormal cell growth. The fear is that inserting these undifferentiated cells into the body may increase the risk of spontaneous cell mutation, which could lead to the formation of tumors. Yet while this type of cell mutation has been seen when using embryonic stem cells, it has not been observed with the use of bone marrow cells.[2]

Using Stem Cells for Pain Management

Due to stem cells’ ability to restore and regenerate, their application toward pain management is a logical step. In particular, stems cells are an exciting treatment solution for conditions such as degenerative disc disease and disc herniation. Disc degeneration, which can occur due to aging or injury, causes the discs to weaken and tear, meaning they no longer provided the needed support for the spine. This can result in herniation (a rupture of the disc, which then presses painfully against spinal nerves).

The current methods for treating degenerative diseases like disc degeneration have their drawbacks: Opioids pose many dangers and side effects and invasive surgery permanently changes the body’s natural structure (sometimes unsuccessfully). Even interventional procedures like injections, which can be extremely beneficial for many patients, don’t affect change on a cellular level or help the body begin to repair itself.

Not only do stem cells work to reduce the pain and inflammation associated with these conditions, but they also work to repair and regenerate the damaged regions.[2] So far, research into the application of stem cells for back pain has been positive, although most of it has taken place utilizing nonhuman subjects. The existing studies do indicate, though, that stem cells can indeed minimize degeneration and start to regenerate disc tissue.[2]

Implications for the Future

Many organizations and companies[3] – including Advanced Pain Management – are currently studying the safety and efficacy of stem cells for the treatment of pain. There are still several aspects that need to be optimized, including at what point in care the treatment is utilized, the time between extraction and implant and the type of conditioning that happens to the cells before transplant,[2] but the preliminary data suggest this is a promising avenue for pain relief.

[1] Weintraub, Karen. “Stem Cells: Plenty of Hope, but Halting Progress.” The New York Times, September 27, 2014. https://www.nytimes.com/2014/09/16/science/stem-cell-progress-begins-to-catch-up-to-promise.html?_r=0.

[2] Zeckser, Jeffrey, Michael Wolff, Jason Tucker, and Josh Goodwin. “Multipotent Mesenchymal Stem Cell Treatment for Discogenic Low Back Pain and Disc Degeneration.” Stem Cells International 2016 (January 11, 2016): 1–13. doi:10.1155/2016/3908389.

[3] UC Davis Health System. “New Study Tests Stem Cells as a Treatment for Degenerative Disc Disease.” February 10, 2016. Accessed January 9, 2017. https://www.ucdmc.ucdavis.edu/publish/news/newsroom/10762.

Published in Stem-cell-therapy

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