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An objective measure of physical pain capable of discriminating subjective pain

MD-FM Thursday April 11, 2013





GENERIQUE
Carillon
 
Sarah:
MD FM, Medical News from around the world with Peter Goodwin.

P1

PETER:
Hello, and with me is Sarah Maxwell. To begin with, identifying patterns of activity in the brain, make it possible, for the first time, to objectively measure physical pain and distinguish it from self-reported pain. That’s according to results, published in the New England Journal of Medicine, which could help practitioners, who currently rely on a patient’s subjective description of pain, improve diagnoses and treatments…
 
SARAH:
Yes, a study with over 100 healthy people, used functional magnetic resonance imagining, f-MRI, to identify patterns of activity across regions of the brain that are associated with heat-induced pain. Researchers then used this neurologic signature to measure each person’s level of pain

Bob-Wager-1: You can apply the pattern to data from a new person and you can accurately predict how much physical pain they are feeling.

SARAH:
That was lead study author Tor Wager from Colorado. He said the pattern showed: a sensitivity and specificity of 94% or more in discriminating painful: heat; from non-painful: warmth, pain anticipation and pain recall. It was also extremely good at discriminating physical pain from emotional pain, induced by recalling a recent romantic breakup

 Bob-Wager-2: What we found is that physical pain and emotional pain are very similar in terms of the overall patterns of brain activity they induce, so in fact there’s nothing that looks more like physical pain than the pain of social rejection that we’ve seen. And so you can’t see the pattern by eye, but what we did is we applied a machine learning algorithm and what we could see then that it’s a different pattern within the same brain circuits.

SARAH:
Dr. Wager added that his team studied cutaneous pain, not pain in the context of a disease, so these findings might not apply to clinical circumstances. But if they do

 Bob-Wager-3: We’re providing some of the initial validation steps towards developing a biomarker for pain based on brain activity. It could eventually be used to confirm people’s pain reports, it could be used to test whether somebody is hyperalgesic or especially sensitive to pain or touch on certain parts of their body and it could also be used to get a better understanding of what kind of pain somebody is experiencing at the brain level, which brain system are contributing to their pain. Eventually treatments could be targeted to those systems

SARAH:
That was Dr. Tor Wager, from Colorado. But he also warned that we shouldn’t use this technology as a pain lie detector.

VIRGULE MUSICALE

P2

PETER:
African Americans who have a particular genotype are more likely to develop late-onset Alzheimer’s disease than Caucasians with the same genotype, according to a study published this week in JAMA
 
SARAH:
Yes, it’s the largest genetic study looking at an African American population to date and showed, that the risk of late onset Alzheimer’s was most strongly associated with the ABC-A7 and APO-E genotypes. These are also known to be associated with an increased risk of the disease for people of European descent: however, the association with ABC-A7 appeared to be 60 percent stronger for African Americans

Bob-Reitz-1: In whites, this gene increases the risk of developing Alzheimer’s by 10 to 20% but in African Americans it increases the risks by 80%. Right now it doesn’t make sense to do genetic testing for this gene. It may at some point be a drug target but first we need to understand why it is important and how it works.

SARAH:
That was lead study author Dr. Christiane Reitz, from New York. She said the strong association found with the ABCA7 genotype suggests, once again, that the lipid metabolism might be involved in the development of Alzheimer’s
 
Bob-Reitz-2: We know that this gene is involved in cholesterol metabolism. In the last ten years there have been several genes discovered in Alzheimer’s disease and about a third of them are actually involved in lipid metabolism. So lipid metabolism, or cholesterol metabolism, seems to be a pathway in Alzheimer’s, that’s also what all the genes right now discovered in whites suggest.

SARAH:
Christiane Reitz, from Columbia Univesity in New York City.

P3

PETER:
More genetics now: and patients with papillary thyroid cancer that have a BRAF, V600E gene mutation, are more likely to die a cancer-related death than patients without this mutation. This finding is from a study published this week in JAMA. But it’s still unclear how these data could be used to reduce mortality in patients with this cancer. Although the BRAF mutation was significantly associated with an increased risk of cancer-related death, overall mortality in this disease is low, and the association wasn’t independent of tumor characteristics.


VIRGULE MUSICALE
 
P4

PETER:
News from the American Association for Cancer Research’s meeting in Washington DC: A recently licensed immuno-conjugate has proven effective in patients with metastatic breast cancer that’s both HER2-positive has PI-3 kinase mutations, making it resistant to standard treatments…
 
SARAH:
Yes, the new agent improved progression-free and overall survival compared to the standard of care lapatinib + capecitabine in patients with HER2-positive metastatic breast cancer, and surprisingly, the benefit was identical whether they presented PI-3 kinase mutations or not. This agent, T-DM1, is a conjugate of the anti-HER-2 drug trastuzumab with the toxin emtansine. Jose Baselga, from New York, presented phase III results at the meeting
 
Bob-Baselga-2: Since HER-2 is overexpressed only in a subset of breast tumors and it is not expressed in normal tissues, the idea is that we could use this antibody as a way to deliver a very potent toxin that would be only internalized in tumors that express HER-2 and would not be internalized in normal tissues. So that was the concept: a very important toxin that otherwise could not be given to patients because of the tremendous side effects that it would induce
 
SARAH:
Dr. Baselga said the drug had a very low side-effect profile and that it opens up the hope of treating some patients with metastatic breast cancer without even having to use chemotherapy.
 
Bob-Baselga-3: We are beginning to identify, within the HER-2 positive population a subgroup of tumors that are so sensitive to anti-HER-2 therapy by itself, without chemo, that I could think of a possibility of opening the gates to non-chemotherapy containing HER-2 therapies

SARAH:
Dr. Jose Baselga, from Memorial Sloan-Kettering Cancer Center in New York.


VIRGULE MUSICALE

P5

PETER:
Cutting dietary salt intake in half could save two and a half million lives across the world each year, according to a study reported in the British Medical Journal
 
SARAH:
Yes, a meta-analysis with over 3200 people showed that lowering salt intake from ten to five grams per day for four weeks, led to reductions in blood pressure, whether people were hypertensive or not to begin with:

Bob-MacGregor-1: The average fall in the whole population (systolic) was about 5 mm of mercury, which from a population point of view is a very large fall in blood pressure, which would have dramatic effects on reducing strokes and heart attacks
 
SARAH:
That was senior study author Professor Graham MacGregor, from Barts and the London Hospitals in the UK, who said these positive effects could be even greater if they were implemented over five, ten or 20 years, however there aren’t any studies to confirm this

Bob-MacGregor-2: Part of that is that it’s extremely difficult for people in the current environment of the developed world to restrict their salt intake because salt is in everything, it’s in bread, etc, when you eat out, cantine, hospital food... it’s very difficult to keep going for more than 4 weeks
 
SARAH:
And according to Professor MacGregor, the responsibility for reducing salt in foods lies primarily with the food industry

Bob-MacGregor-3: What we’re doing is getting the food industry to slowly take out the huge amounts of salt they unecessarily put into food. In the UK and other developed countries, 80 percent of our salt intake comes from the food industry, we have no choice over it. So we have to get them to act, that’s the really important public health policy
 
SARAH:
Graham MacGregor, from the London.


BREVE 1 Sur fond musical

PETER:
Finally, in brief

Patients who are HIV positive, have greater long-term risks of heart failure after an acute myocardial infarction than patients without the virus. That’s the finding of a study published in Circulation, which analysed data from a nationwide French hospital medical information database. Short-term risks however, appeared comparable between HIV-infected and uninfected patients.

And
 
BREVE 2

Schools that follow strict meal nutrition standards might improve their students’ weight status, according to a study in JAMA Pediatrics. Even though many kids are obese, excess body mass was reduced, in kids who ate school dinners, in American states where the schools stuck to government recommendations about energy content, fibre, fruit and the like.  In states not applying the limits, school dinners did bring so much benefit.  

That's all from MDFM for now. Sarah Maxwell and I will be back with more next week, so until then from me Peter Goodwin, goodbye

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