Clearly there is a huge role for parents in their child's development blended with the genetic and epigenetic influences as the recent New Scientist feature suggests: http://www.newscientist.com/article/mg20827852.500-epigenetics-can-take-us-to...

Melanie Thernstrom has written a superb book based on a historical, philosophical, and scientific review of pain: The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering. Herself a victim of chronic pain, she brings a personal perspective to the subject and also includes informative vignettes of doctors and patients she encountered at the many pain clinics she visited in her investigations. She shows that medical treatment of pain is suboptimal because most doctors have not yet incorporated recent scientific discoveries into their thinking, discoveries indicating that chronic pain is a disease in its own right, a state of pathological pain sensitivity.

Chronic pain often outlives its original causes, worsens over time, and takes on a puzzling life of its own… there is increasing evidence that over time, untreated pain eventually rewrites the central nervous system, causing pathological changes to the brain and spinal cord, and that these in turn cause greater pain. Even more disturbingly, recent evidence suggests that prolonged pain actually damages parts of the brain, including those involved in cognition.

Sometimes the original problem creates new ones as the patient distorts posture and avoids exercise in an attempt to reduce the pain.  In chronic pain, the protective mechanism of avoidance becomes maladaptive. Muscles atrophy from disuse and new sources of pain develop. Jerome Groopman, MD, in The Anatomy of Hope, told how he conquered years of chronic back pain by realizing that his pain was not a warning to avoid further damage but a false message that he could refuse to listen to; with exercise and physical therapy he rebuilt his muscles and became pain-free.

Dr. John Sarno believes that chronic musculoskeletal pain is a manifestation of “tension myositis syndrome” due to repressed negative emotions. He recommends renouncing all treatments, accepting that pain is only in the mind, and resuming normal activities. I don’t accept his psychosomatic premise, but there is a grain of truth in his method. If patients can re-frame their thinking and resume normal activities despite the pain, they are more likely to improve than if they maintain the self-image of a sick, disabled victim.

Distraction is effective in removing the awareness of pain. Thernstrom tells us that as she got better,

I wasn’t aware of being in pain all the time, but whenever I thought about whether I had pain, I always did. There were pain-free moments owing to my being preoccupied — happily or unhappily — with something else, but I was never able to “catch” a pain-free moment and enjoy it, which meant that, in some sense, I was always in pain.

Pain perception in the brain involves two different pain systems: one of pain perception and one of pain modulation. Acute injuries always hurt more later as the modulation effects diminish and the brain releases neurotransmitters into the spinal cord that amplify incoming signals and augment pain. This serves the adaptive purpose of enabling flight at first and then enforcing rest. It is possible to induce complete analgesia in humans and animals by electrically stimulating pain-modulating areas of the brain. Various cognitive and affective states activate the two systems, especially attention and expectation. Simply asking patients to think about their pain activates the pain-perception circuits. Anticipation of a placebo effect causes the pain-modulating release of endorphins in the brain.

One medication requires the placebo effect for all of its effectiveness. An intriguing 1995 clinical trial proved an analgesic called proglumide to be a more effective pain reliever than a placebo when both groups were told they were being given an exciting new painkiller. But then subjects were slipped proglumide without their knowledge, thus ensuring they had no placebo effect, they felt no relief at all. None.

It turns out proglumide enhances the endorphin response by blocking cholecystokinin receptors.  Thernstrom speculates that drugs could be designed to enhance or create a placebo effect. Hmm… what would medical ethicists have to say about that? For that matter, how can a treatment still be called a placebo if it is shown to have the effect of producing endorphins in the brain?

Opioids relieve pain, but they are both under-used and over-used. If acute pain were better controlled, fewer patients would develop chronic pain. On the other hand, many chronic pain patients develop opioid-induced hyperalgesia, where their body becomes more sensitive to pain stimuli or even ordinary stimuli; they develop pain in parts of their bodies remote from the original injury site.

Caution is required. Relieving pain sometimes causes harm. A phase 3 study of tanezumab was recently halted by the FDA. Although the drug relieved the pain of osteoarthritis, it also resulted in more joint failure, presumably because there was more wear and tear on the joints when pain was absent.

The Pain Chronicles is a fascinating glimpse into the world of pain sufferers as well as a good overview of our current scientific knowledge. It suggests avenues of investigation that may vastly improve our management of pain. I highly recommend it to anyone who wants to know more about any aspect of the pain experience and the science.

I am always interested in reading and hearing about individual's experiences. This could be a worthwhile insight.

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Editorial: Don't get too happy

It's good for your health, it makes you smarter – and our brains are hard-wired for it. New Scientist counts our reasons to be cheerful

DOOM and gloom are the order of the day across most of the western world. Economies are faltering, the cost of living is going up and many people's real income is falling. For some, unemployment is a reality now or in the near future. If the pursuit of happiness is supposed to be one of our goals, prospects appear bleak.

Take a closer look, and it isn't that simple. In fact, economic hard times have little impact on how happy most people feel. Indeed, it would appear that we humans are built to experience happiness, and understanding why is helping us work out what enhances our feelings of well-being. It even points to ways we can adapt to cope with the hardships the recession may bring, and keep smiling whatever happens.

One thing that is clear is that once life's basics are paid for, the power of money to bring happiness is limited. In fact, it can be positively harmful to our sense of well-being. Jordi Quoidbach of the University of Liège, Belgium, and colleagues recently asked a group of people to taste a piece of chocolate in their laboratory. They found that the wealthier members of the group spent less time savouring the experience, and reported enjoying the chocolate less than the subjects who weren't so well off. The same was also true of one group in a separate experiment. This time, half the people had been primed with images of money before they tasted the chocolate. These participants enjoyed the tasting less than a group who had not seen the images, suggesting that just the thought of money is enough to stem our enjoyment of life's simple pleasures (Psychological Science, vol 21, p 759).

So just what is it that makes us happy? Happiness can take the form of many different positive emotions (See "Happiness is..."), and some hints of what makes us happy may come from work that questions why these emotions first evolved. The answer isn't as obvious as it is in the case of negative emotions. These are clearly beneficial in the rough and tumble of survival: anger readies us to fight an opponent, fear makes us run away from danger, and disgust steers us away from contaminated foods and other sources of infection. Although there is no shortage of evidence that feelings of pleasure - obtained by finding a tasty meal or a sexy mate, for example - are important in rewarding and consolidating beneficial behaviours, it is harder to explain how the more diffuse positive emotions such as awe, hope or gratitude evolved.

This troubled psychologist Barbara Fredrickson of the University of North Carolina at Chapel Hill, so she started looking for evolutionary benefits that pleasure might confer. "I thought there must be more to it than this," she recalls.

Fredrickson's "broaden and build" theory proposes that happiness and similar positive states of mind improve our cognitive capacities while we are in safe situations, allowing us to build resources around us for the long term. That's in marked contrast to the effects of negative emotions like fear, which focus our attention so we can deal with short-term problems. "Positive feelings change the way our brains work and expand the boundaries of experience, allowing us to take in more information and see the big picture," Fredrickson argues.

Positive feelings change the way our brains work, allowing us to take in more information

Since she proposed it in 1998 in the Review of General Psychology (vol 2, p 300), her theory has gathered a wealth of experimental support. Eye-tracking and brain-imaging experiments, for example, have revealed that positive moods increase and broaden the scope of visual attention, helping the brain gather more information.

A happy solution

Feeling good has also been shown to improve people's creativity and ability to solve problems. In one experiment, subjects were shown a video of comedy bloopers to lighten their mood, before being presented with a practical problem involving a box of matches, a box of tacks and a candle. They were told to attach the candle to a pinboard in such a way that wax didn't drip on the floor (the solution is to use the matchbox as a plinth for the candle). The experimenters found that people who had viewed the comedy clips were more likely to solve the problem than controls who saw a mathematics documentary intended to put them in a more neutral mood (Journal of Personality and Social Psychology, vol 52, p 1122).

Other experiments have found that a good mood improves people's verbal reasoning skills (Proceedings of the National Academy of Sciences, vol 104, p 383). And various studies have shown that when people are in a good mood, their social skills improve: they become more gregarious and trusting of others, and deal more constructively with criticism.

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Optimistic Twaddle?

Tue Sep 28 21:29:48 BST 2010 by Cannonfodderson

Here we have some 'cheer up your not dead yet' kind of optimistic nonsense and yet there's another article on your website saying there's only 5 billion years till the end of the Universe.

Optimism ? I'm not too happy about that

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Useful measures to identify factors that can affect outcomes: FABQ-PA & PCS

Good new information about how injured nerves grow back, in particular identifying Schwann cell and fibroblast activity and inter-communication.

More evidence for mindfulness.

Pain is influenced by hormone activity. Focus and concentration are affected by pain. It is good to think about these interrelations and how we can consider our treatments in response. If pain is amplified at certain times in the cycle and focus is a problem at particular points or when in pain, education can be tailored and exercise programmes prescribed accordingly.

Expected findings from clinical experience, good to quantify.