Chronic pain may mean more falls for older people

Falls can be devastating for the elderly, leading to joint replacements, pain and sometimes death. A new study finds that having chronic pain may lead to more falls in older people.

Participants in the study included 749 men and women age 70 and older who were part of the Maintenance of Balance, Independent Living, Intellect and Zest in the Elderly study in Boston. They were given a health assessment by a nurse and were asked to record any falls they had during an 18-month period.

At the beginning of the study, 40% of the men and women said they had chronic pain in more than one joint, and 24% said they had chronic pain in one joint. During the study period, 1,029 falls were logged, and more than half the participants reported they fell at least once.

However, researchers found that those who said they had pain in more than one joint had a 50% greater chance of falling than those who had no pain.

They also discovered a link between pain severity and the risk of falls in the short-term. Those who rated their pain as severe or very severe for a month had a 77% increased chance of falling in the following month, compared with those who had no pain.

In the study, the authors wrote, "The findings provide evidence suggesting that the common complaint of the aches and pains of old age is related to a greater hazard than previously thought. Daily discomfort may accompany not only difficulties in performing daily activities but equally as important may be a risk for falls and possibly fall-related injuries in the older population."

The study appears in this week's issue of the Journal of the American Medical Assn.

-- Jeannine Stein

In pain? Just say 'om'

Women undergoing natural childbirth have long endorsed the concept that you can think your way past the pain. Using meditation or guided imagery, it's possible to transcend pain, at least to some degree.

Two new studies provide more evidence that something as simple as thinking about a pretty image can help with mild pain. In one study, researchers at the University of Montreal gave 13 study participants mildly painful electric shocks which caused a knee-jerk reaction that could be measured by magnetic resonance imaging. During the shocks, participants were shown a series of images that were pleasant (such as water-skiing in summer), vicious (a bear) or neutral (a book). They found that the pain of the shocks was perceived as being worse when people were looking at unpleasant pictures. The study was published today in the Proceedings of the National Academy of Sciences.

"Emotions -- or mood -- can alter how we react to pain since they're interlinked," the lead author of the study, Mathieu Roy, said in a news release. "Non-pharmaceutical interventions -- mood enhancers such as photography or music -- could be used in healthcare to help alleviate pain. These interventions would be inexpensive and adaptable to several fields."

In another study published this week, in the Journal of Pain, researches found that relatively short and simple mindfulness meditation training can help with pain management. Other studies have shown that people who meditate regularly deal better with pain. But the new study showed that a three-day, one-hour-a-day program can produce similar effects.

The authors of the study, from the University of North Carolina, Charlotte, suggest that mindfulness training reduces the awareness of pain and sensitivity to it because it trains the brain to pay attention to the sensations at the current moment rather than anticipating future pain or dwelling on past pain. This approach also reduces anxiety.

"With the meditation training they would acknowledge the pain, they realize what it is, but just let it go," the lead author of the study, Fadel Zeidan, said in a news release. "They learn to bring their attention back to the present."

-- Shari Roan

Photo: A nurse administers a flu shot in Provo, Utah. Credit: George Frey / Bloomberg

The healing power of yoga for low back pain

In some neighborhoods you can throw a rock and hit a yoga studio. In others, however, yoga classes are practically nonexistent, even though the practice has been shown in studies to have beneficial health effects.

Researchers took yoga to racially diverse neighborhoods in Boston to see whether three months of steady practice would have any consequence on chronic low back pain. Although the condition is common, minorities may not always have adequate access to treatments such as pain relievers, physical therapy and surgery.

For this pilot study, 30 people, average age 44, were recruited from community health centers in Boston in low-income areas that were racially diverse. They were randomly split into two groups -- one did hatha yoga for 12 weeks, taking classes that included poses and breathing techniques. They were also encouraged to practice at home and were given a yoga CD and handbook, plus a mat, strap and block, and were told to continue their regular medical routine. Participants in the other group continued their usual treatment that included seeing their doctor and taking medication.

After the 12 weeks, those in the yoga group had far lower pain scores than the control -- their pain decreased by a third, compared with 5% in the control group. The yoga group also decreased their use of pain medication by 80%, while the control group's medication didn't change. At the end of the study, 73% of the yoga group said they had overall improvement in back pain, compared with 27% of the control group.

"Our pilot study showed that yoga is well-received in these communities and may be effective for reducing pain and pain medication use," said Dr. Robert Saper in a news release. Saper, the lead author of the study, is also an assistant professor of family medicine at the Boston University School of Medicine and director of integrative medicine at Boston Medical Center. The study appears in the November issue of the journal Alternative Therapies in Health and Medicine.

-- Jeannine Stein

Photo credit: Kate Brooks / For The Times

Older people with knee pain may get help from tai chi

Knee pain from osteoarthritis is a common and often chronic ailment for older people. But a new study finds that practicing tai chi exercises may not only reduce osteoarthritis pain, but improve function as well.

Tai chi is a Chinese martial art with a mind-body connection that emphasizes flexibility, balance and strength. Tai chi has been used in a number of research studies because of its health benefits. Many believe that practicing the slow, controlled movements reduces stress while enhancing muscle coordination and flexibility and increasing energy.

Forty people with knee osteoarthritis, average age 65, were recruited for the study by researchers from the Tufts University School of Medicine. Half were randomly placed in hour-long twice-weekly tai chi classes for three months. The classes included self-massage, tai chi movements, breathing techniques and relaxation. Participants were also asked to practice tai chi for at least 20 minutes a day at home while maintaining their usual physical routine.

The other 20 participants acted as the control group, attending twice-weekly hour-long sessions on osteoarthritis that included information on diet and nutrition, plus ways to treat the condition and how to handle stress. They also took part in full-body stretching exercises and were encouraged to stretch for 20 minutes a day at home and follow their regular physical regimen.

After the three months, those in the tai chi group saw a substantial drop in knee pain compared with the control group. The tai chi group also saw more improvements in function, depression and health status.

In the study, the authors wrote that though the exact mechanisms are not know for how tai chi may improve knee osteoarthritis, "synergy between its physical and mental components likely plays a major role. First, tai chi may enhance cardiovascular benefits, muscular strength, balance, coordination, and physical function. All of these are thought to be able to reduce joint pain."

The study appears in the November issue of the journal Arthritis Care & Research.

-Jeannine Stein

Photo credit: Daniel Sorabji / AFP/Getty Images

A surprising finding about the placebo effect

Scientists like to say the placebo effect is all in your head. Turns out, it’s actually in your spinal cord.

The placebo effect, of course, is the well-known phenomenon in which patients who think they are getting medical treatment report that they feel better, even when they get only a sugar pill or other fake therapy.

Researchers in Hamburg, Germany, convinced 15 men to test a “lidocaine cream” that was strong enough to work as a local anesthetic. The researchers drew red and green boxes on the volunteers’ forearms. Then they applied the ointment to the green box and rubbed a “control cream” into the red box.

After waiting 10 minutes for the “lidocaine” to take effect, they applied a hot stimulus to one of the squares and kept it there for 20 seconds. Then they tested the other square. After each trial, the volunteers were asked to rate the intensity of their pain. The tests were repeated 14 more times.

As you may have guessed by now, the “lidocaine” and “control” creams were identical. And yet, the volunteers told researchers that the "lidocaine cream" reduced their pain by an average of 26%, the researchers report online today in the journal Science.

The scientists used functional MRI scans to track how the spinal cord responded to the painful stimuli. Sure enough, they detected less activity in the spinal cord when patients thought they were protected by the lidocaine.

The results show that a painful stimulus need not travel all the way to the brain to come under the influence of “psychological factors,” the researchers wrote. All it needs to do is reach the spinal cord – the first stop along the central nervous system – and the placebo effect will kick in.

-- Karen Kaplan

Rodent of the week: Gabapentin may be unsafe for developing brains

A study performed in mice and in cell culture suggests that the heavily prescribed drug gabapentin halts the formation of new synapses, or nerve connections, in the brain. That ability may be the reason the drug is effective in treating epileptic seizures and pain. But the findings also suggest that the medication may harm fetuses and young children, whose brains are still developing.

Stanford University researchers examined the interaction between neurons and brain cells called astrocytes. Previous studies showed that a protein that astrocytes secrete, thrombospondin, is critical to the formation of the brain's circuitry. In the study, researchers found that thrombospondin binds to a receptor, called alpha2delta-1, on the outer membrane of neurons. In a study in mice, they showed that the neurons that lacked alpha2delta-1 could not form synapses in response to the presence of thrombospondin.

Alpha2delta-1 is the receptor for gabapentin. That has been known, although scientists did not understand how gabapentin worked. But the new research revealed that when gabapentin was given to mice, it prevented thrombospondin from binding to the receptor, thus stopping the synapse formation.

While gabapentin, which is sold under the trade name Neurontin, does not dissolve pre-existing synapses, it prevents the formation of new ones. That's why the medication may be dangerous if given to pregnant women or young children, the authors said. The majority of the brain's synapses are formed in utero and early childhood.

"It's a bit scary that a drug that can so powerfully block synapse formation is being used in pregnant women," Dr. Ben Barres, a professor of neurobiology and the senior author of the study, said in a news release. "This potential effect on fetal brains needs to be taken seriously. Right now, doctors have the view that gabapentin is the safest anticonvulsant. There is no question that pregnant women with epilepsy who have been advised by their neurologists to continue their anticonvulsant treatment with gabapentin during their pregnancy should definitely remain on this drug until instructed otherwise. But there is no long-term registry being kept to track gabapentin-exposed babies. Our findings are saying that we need to be following up on these newborns so that their cognitive performance can be studied as they grow older."

The study is published online in the journal Cell.

-- Shari Roan

Photo: Advanced Cell Technology Inc.

The cost of high heels may be measured in pain

Beauty is pain, as the saying goes. Now there's evidence to back it up: Wearing high-heeled shoes now may mean suffering foot pain later, according to a new study.

Study subjects were asked whether they felt pain, aching or stiffness in one or both feet on most days, and if so, what part of their foot hurt (nails, forefoot, hindfoot, heel, arch and ball of the foot). The 3,372 participants were from the Framingham Foot Study, made up of people from the Framingham Study Original Cohort and the Framingham Offspring Cohort who were evaluated from 2002 to 2008. Numbers of men and women were about equal.

Their most common footwear worn currently and previously was divided into several categories and among age groups. The shoe categories were: poor (high-risk shoes that lacked support and structure, such as high heels, sandals and slippers), average (mid-risk shoes with hard or rubber soles such as work boots) and good (low-risk shoes offering good support and safety, such as sneakers).

One-fourth of all participants said they had generalized foot pain on most days. The researchers also said that in women they found an increased risk between having pain in the hindfoot and wearing poor shoes in the past, even after adjusting for weight and age. Fewer men reported pain than women (19% versus 29%), but only 1.6% of men said they wore shoes in the poor category.

In the study, the researchers said that wearing good shoes makes sense for protecting the hindfoot from pain. They wrote: "It is also possible that the single association seen at the hindfoot is due to the tightness of the heelcords that might result from sustained use of high heels." If this is the case, they add, stretching exercises might offset problems caused by poor shoes.

The study appears in the October issue of the journal Arthritis Care & Research.

-- Jeannine Stein

 Photo credit: Peter Foley / EPA

When pain makes you feel old before your time

Having chronic pain can affect every aspect of a person's life, making daily activities a struggle. It may even make people feel older before their time.

A recent study validates those feelings. It found that people often troubled by pain may have the same level of functional limitations as those who suffer no chronic pain but are two to three decades older.

Researchers looked at data from 18,531 people ages 50 and older who took part in the 2004 Health and Retirement Study. Subjects were asked whether they were often troubled by pain and if the pain was mild, moderate or severe. Those in the moderate or severe category were categorized as having significant pain. The participants were also quizzed about their physical limitations in terms of mobility, stair climbing, upper-body tasks and daily living activities such as bathing, dressing and eating.

Almost one-fourth of all study subjects said they were often bothered by significant pain. They were also, on average, as limited functionally as people who were 20 to 30 years older who didn’t suffer from substantial pain. About a third of people ages 50 to 59 who were in pain, for example, said they could climb several flights of stairs without difficulty, compared with 39% of people 80 to 89 who weren't in pain. Study participants ages 50 to 59 who had pain also had higher rates of dependence and difficulty with daily tasks than people 80 to 89 who didn't have pain.

"When we think about taking care of patients in pain, the question is not just how do you manage their pain, but how do you help them to function better?" lead author Dr. Kenneth E. Covinksy, a staff physician at the San Francisco Veterans Affairs Medical Center, said in a news release.

The study appears in the September issue of the Journal of the American Geriatrics Society.

-- Jeannine Stein

Photo credit: Alex Cruz / EPA

Children need pain relief following surgery

It has taken many years for the medical profession to realize that children feel pain just like adults do. Today hospitals are much more aggressive about treating pediatric pain. But parents may not be getting the message. A study in the new issue of the journal Pediatrics found that a stunning number of children experience significant pain at home following an outpatient tonsillectomy. Parents are not providing enough pain medication to keep their children comfortable.

The study, by a research team at UC Irvine and Children's Hospital of Orange County, involved 261 children ages 2 to 12 who underwent routine tonsillectomy and adenoidectomy. Parents rated their children's pain in the days following surgery and reported on how much medication they gave their children. The study found that, on the first day home, 86% of children had significant pain, yet 24% received either no pain medication or only one dose throughout the entire day. On Day 3, 67% of children experienced significant pain, yet 41% received no dose or only one dose.

Studies show that many children experience serious pain following a tonsillectomy or adenoidectomy, and the pain can last for a week. It's unclear why parents don't provide enough pain medication but possible explanations include parents' fears about the drugs, such as dependence or overdose; the mistaken assumption that young children can feel severe pain; or a belief that pain medication should be used only as a last resort. In reality, pain medication should be given at regular intervals during the post-operative period to prevent surges of severe discomfort, doctors say.

Doctors need to do a better job explaining how to use pain medication, the authors said.

"There is a pressing need for researchers to focus attention on the translation of knowledge to target children's pain management at home," they wrote.

-- Shari Roan

Photo: Glenn Koenig / Los Angeles Times

Yoga helps relieve chronic back pain

Chronic back pain is difficult to treat and causes loads of misery. But something as simple as twice-weekly yoga appears to relieve pain and improve mood in people with the condition.

The study, published in this month's issue of the journal Spine, was a three-year, $400,000 research project funded by National Institutes of Health. Researchers assigned 90 people with chronic low back pain to a yoga group or a control group that received standard medical care.

Those in the yoga group participated in 24 weeks of biweekly yoga classes designed for people with chronic lower-back pain. Six months after the study ended, those in the yoga group reported significantly more improvements in pain and functionality compared with subjects in the other group. In addition, depression was much lower in the yoga subjects. The use of pain medication was reduced, but that reduction was similar in both groups.

"The yoga group had less pain, less functional disability and less depression compared with the control group," Kimberly Williams, the lead investigator, from West Virginia University, said in a news release. "Proponents of yoga have long described its benefits in reducing back pain. But not everyone was convinced. This is a much bigger, much more rigorous evaluation than had been done before."

The classes were taught by an instructor certified in Iyengar yoga, a type that emphasizes posture.

-- Shari Roan

Photo credit: Tony Gutierrez  /  Associated Press