Publications
The Journal of Pain • Volume 10, No. 6, June 2009
APS members and subscribers to The Journal of Pain may view this issue online at www2.jpain.org. Abstracts and table of contents of each issue of The Journal of Pain are available for online viewing.
The following news highlights summarize selected articles in the June 2009 issue of The Journal of Pain, the peer-reviewed scientific journal of APS.
Note: The opinions and ideas expressed in articles appearing in The Journal of Pain do not necessarily reflect those of the editor and publisher or of the American Pain Society.
Comorbid Pain and Depression: Who is at Risk?
Lisa Renee Miller and Annmarie Cano; Wayne State University, Detroit
It is well known that chronic pain and clinical depression go together, but a study in The Journal of Pain shows that the connection between pain and depression is strongest in middle-age women and African Americans.
Researchers at Wayne State University studied a representative community sample of 1,100 Michigan residents and found that the incidence of chronic pain, defined as pain persisting for 6 months, was 22%. Approximately 35% of those with chronic pain said they had depression, but mood problems were not associated with a particular pain condition or pain site. Researchers evaluated several demographic factors and found that older age was generally related to chronic pain but not with comorbid depression. They noted that depression tends to decrease with age while pain tends to increase.
From the data, the authors concluded that in middle-age women chronic pain might not be the cause of depression but preexisting mood problems could be associated with development of chronic pain. They further concluded that depression can increase vulnerability to experiencing persistent pain.
The study also showed that African Americans were more likely to have chronic pain with depression than Caucasians. Further analysis showed that racial differences were not attributable to possible socioeconomic factors but might be associated with differences in the use of pain coping strategies. Though income was not a significant risk factor for the study, the authors indicated that occupational factors, such as physically demanding work and poor or no health insurance coverage, may account for the link between lower socioeconomic status and pain, and that financial strain and stress are closely linked with depression.
From their findings, the authors recommend that clinicians screen pain patients for depression and pay close attention to middle-age women and African Americans for whom risk for comorbid depression is the highest.
Changes in Gray Matter Intensity in Fibromyalgia: Correlation with Dopamine Metabolism
Patrick B. Wood, Michael F. Glabus, Ryan Simpson, and James C. Patterson II; Louisiana State University
Previous studies have shown that fibromyalgia is associated with reductions in gray matter in parts of the brain, but the exact cause is not known. Using sophisticated brain imaging techniques, researchers from Louisiana State University found that alterations in levels of the neurotransmitter dopamine might be responsible for gray matter reductions.
Magnetic imaging resonance data from 30 female fibromyalgia patients were compared with 20 healthy women of the same age. The primary objective of the study was to confirm original findings about reduced gray matter density in a larger sample of fibromyalgia patients. They explored whether there is a correlation between dopamine metabolic activity and variations in the density of gray matter in specific brain regions.
Results showed there were significant gray matter reductions in the fibromyalgia patients, which supports previous research. In addition, the fibromyalgia patients showed a strong correlation of dopamine metabolism levels and gray matter density in parts of the brain in which dopamine controls neurological activity. The authors concluded that the connection between dopamine levels and gray matter density provide novel insights to a possible mechanism that explains some of the abnormal brain morphology associated with fibromyalgia.
Effects of Traditional Cupping Therapy in Patients with Carpal Tunnel Syndrome: A Randomized Control Trial
Andreas Michalson1,2, Silke Bock3, Rainer Lüdke4, Thomas Rampp3, Marcus Baecker3, Jürgen Bachmann5, Jost Langhorst3, Frauke Musial3, and Gustav Dobos3
1 Immanuel Hospital Berlin, Department of Internal and Complementary Medicine, Berlin, Germany
2 Institute of Social Medicine, Epidemiology and Health Economics, Charité-University Medical Centre, Berlin, Germany
3 Kliniken Essen-Mitte, Department of Internal and Integrative Medicine, University Duisburg-Essen, Essen, Germany
4 Karl and Veronica Carstens Foundation, Essen, Germany
5 Augusta-Medical Clinic, Hattingen, Germany
A German study published in The Journal of Pain showed that an external suction technique mainly used outside the United States, called cupping, is effective for providing temporary relief of pain from carpal tunnel syndrome (CTS).
Researchers from Immanuel Hospital Berlin randomly divided 52 CTS patients into treatment and control groups. The treatment group was given wet cupping therapy in which cupping glasses are applied to skin overlaying the trapezius muscle following 5 to 10 skin punctures with a sterile lancet. A partial vacuum is created by electromechanical or manual suction within the cupping glass after it is applied to the skin.
The technique is used as a healing method in China, India, Arabia, Central Europe, and parts of Africa. Cupping is applied to defined zones of the shoulder triangle which are connective tissue zones at the shoulder-neck region. The technique is believed to increase microcirculation to help relieve CTS symptoms.
Results showed that CTS patients given cupping treatment experienced a highly significant decrease in CTS pain and other symptoms. A single treatment improved functional ability and quality for life for a week. The authors offered three possible explanations for the positive therapeutic action:
- Local bloodletting caused by cupping altered tissue perfusion and metabolism and may have affected the medial nerve function
- Cupping may have antinociceptive effects
- Cupping therapy simply might generate a powerful placebo effect.
Patients tolerated the treatments very well. In clinical practice, cupping can be performed conveniently and repeatedly. The authors noted that further studies are needed to assess the long-term value of cupping therapy for treatment of CTS pain.
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