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Using Virtual Reality, Not Opioids, to Reduce Pain (Video)
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But many doctors and nurses say this rating system isn't working and they're trying a new approach.[contextly_sidebar id=\"PzT9DEOa22PlTyV4kUDRN8kM4A2CX5Tx\"]\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.[contextly_sidebar id=\"gNyBEO7kaaOOQQPLiTFHH1VcWAsQe2Bq\"]\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.[contextly_sidebar id=\"ClUbqCuoEqdLIyjzgS1I1irhMb4fhntn\"]\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.[contextly_sidebar id=\"jBdk15Gcdb1FQXh8PlzSvMvHZmeTdBu9\"]\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"When you go to the doctor in pain, you'll probably be asked to rate your discomfort on a scale of 0 to 10. But doctors say there may be a better way to assess pain.","status":"publish","parent":0,"modified":1532390120,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":37,"wordCount":1147},"headData":{"title":"Words Matter When Talking About Pain With Your Doctor | KQED","description":"When you go to the doctor in pain, you'll probably be asked to rate your discomfort on a scale of 0 to 10. But doctors say there may be a better way to assess pain.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Words Matter When Talking About Pain With Your Doctor","datePublished":"2018-07-24T19:00:16.000Z","dateModified":"2018-07-23T23:55:20.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"443544 https://ww2.kqed.org/futureofyou/?p=443544","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/07/24/words-matter-when-talking-about-pain-with-your-doctor/","disqusTitle":"Words Matter When Talking About Pain With Your Doctor","source":"Health","nprByline":"Patti Neighmond, NPR","nprImageAgency":"Lynn Scurfield for NPR","nprStoryId":"626202281","nprApiLink":"http://api.npr.org/query?id=626202281&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/07/23/626202281/words-matter-when-talking-about-pain-with-your-doctor?ft=nprml&f=626202281","nprRetrievedStory":"1","nprPubDate":"Mon, 23 Jul 2018 11:59:00 -0400","nprStoryDate":"Mon, 23 Jul 2018 05:01:00 -0400","nprLastModifiedDate":"Mon, 23 Jul 2018 11:59:51 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/07/20180723_me_words_matter_when_talking_about_pain_with_your_doctor.mp3?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","nprAudioM3u":"http://api.npr.org/m3u/1631434748-973f75.m3u?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","path":"/futureofyou/443544/words-matter-when-talking-about-pain-with-your-doctor","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/07/20180723_me_words_matter_when_talking_about_pain_with_your_doctor.mp3?orgId=1&topicId=1066&d=236&p=3&story=626202281&ft=nprml&f=626202281","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>If you're in the hospital or a doctor's office with a painful problem, you'll likely be asked to rate your pain on a \u003ca href=\"https://paindoctor.com/pain-scales/\" target=\"_blank\" rel=\"noopener\">scale\u003c/a> of 0 to 10 – with 0 meaning no pain at all and 10 indicating the worst pain you can imagine. But many doctors and nurses say this rating system isn't working and they're trying a new approach.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The numeric pain scale may just be too simplistic, says \u003ca href=\"https://www.urmc.rochester.edu/people/21192807-john-d-markman\" target=\"_blank\" rel=\"noopener\">Dr. John Markman\u003c/a>, director of the Translational Pain Research Program at the University of Rochester School of Medicine and Dentistry. It can lead doctors to \"treat by numbers,\" he says and as a result, patients may not be getting the most effective treatment for their pain.\u003c/p>\n\u003cp>Take the case of 33-year-old Adam Rosette, who was recently hospitalized for \u003ca href=\"https://orthoinfo.aaos.org/en/diseases--conditions/fibrous-dysplasia/\" target=\"_blank\" rel=\"noopener\">fibrous dysplasia\u003c/a>, a bone disorder that made it nearly impossible for him to chew or even speak. After brain surgery to remove benign tumors related to the disorder, he was definitely in pain. But he was reluctant to label the pain too high.\u003c/p>\n\u003cp>\"I don't think I ever answered higher than a '7' because an '8' would be, in my mind, like I'm missing half of my body or a limb,\" he recalls.\u003c/p>\n\u003cp>On the pain scale a rating of 4 to 7 is considered moderate. Mild pain is rated 1 to 3. Over 7 is considered severe.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Today, Rosette has recovered and is pain-free, but he wonders if \"low balling\" his pain level while in the hospital, meant he wasn't given adequate pain medication.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"You realize you got less medicine and it's been eight hours and they're not allowed to give you more for a while,\" Rosette says.\u003c/p>\n\u003cp>If your doctor gets the wrong idea about your pain, it's not just going to affect your comfort — it can affect your treatment. Markman says that especially after an injury, there's therapeutic value to keeping the pain tamped down, so that you can keep up with physical therapy.\u003c/p>\n\u003cp>For chronic pain, being clear can help clinicians choose the right mix of therapies or medications to allow you to stay as active as possible. And staying active can help manage chronic pain, says \u003ca href=\"https://anesthesiology.duke.edu/?page_id=834374\" target=\"_blank\" rel=\"noopener\">Dr. William Maixner\u003c/a>, with Duke University School of Medicine and current president of the American Pain Society.\u003c/p>\n\u003cp>Exercise, he says, \"causes the release of a number of anti-inflammatory substances from the muscle that can help diminish pain and pain processing and make the individual more resilient.\"\u003c/p>\n\u003cp>To find out more about how the numerical pain scale was affecting treatment, Markman and colleagues at the University of Rochester did a study, which they will present at the World Congress on Pain in Boston in September. The research analyzed data from other studies, which asked chronic pain patients to rate their pain using both numbers and words.\u003c/p>\n\u003cp>Patients were asked to rate their pain on a scale of 0 to 10, and they were also asked the question, \"Is your pain tolerable?\"\u003c/p>\n\u003cp>Surprisingly, three quarters of the patients who rated their pain between 4 and 7 on the numerical scale, a range that typically calls for higher doses of medications, also described their pain as \"tolerable\" — a description that normally means no more pain treatment is needed.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>This showed the danger of relying only on a number, Markman says. \"If you were just treating by the numbers you might say, 'Well, someone has a pain that is 6 [out of]10. I feel obligated to do something about that ... to fix that number just like you might fix their blood pressure or their blood glucose,' \" he says.\u003c/p>\n\u003cp>If clinicians just look at a number, Markman says, they may be more likely to over-treat or prescribe more medication, which can be worrisome during an era of concern about opioid abuse and addiction.\u003c/p>\n\u003cp>So if today's pain scale isn't working well for patients and doctors, what's the alternative?\u003c/p>\n\u003cp>Many health care providers are trying to come up with a system that involves words, not numbers.\u003c/p>\n\u003cp>\"I never look at just the pain scale,\" says \u003ca href=\"https://www.uclahealth.org/chrystina-jeter\" target=\"_blank\" rel=\"noopener\">Dr. Chrystina Jeter\u003c/a>, an anesthesiologist and pain management specialist with UCLA Health, who was Rosette's doctor.\u003c/p>\n\u003cp>Using words to describe pain brings greater specificity to the measurement of pain, says Maixner.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>If patients can describe their pain precisely, he says, their appointment with a health care provider will be much more focused, allowing the physician to \"come to a decision about treatment in a much more rapid and logical way.\"\u003c/p>\n\u003cp>Here's advice for the next time you need to talk to your doctor about your pain.\u003c/p>\n\u003cp>\u003cstrong>Get Descriptive\u003c/strong>\u003c/p>\n\u003cp>You can help doctors understand just how debilitating your pain is by being more descriptive.\u003c/p>\n\u003cp>\"It's perfectly OK to be a little more flowery in the description of pain,\" says Jeter. \"My pain is aching, burning. What does it feel like to you? Where is it? Does it move?\"\u003c/p>\n\u003cp>Jeter typically asks patients to compare their current pain to the worst pain they ever had, such as childbirth or kidney stones. This helps put their pain in context, she says, and may help them realize their pain may not be that bad after all.\u003c/p>\n\u003cp>\u003cstrong>Describe Your Day\u003c/strong>\u003c/p>\n\u003cp>It can be helpful to talk about how your pain waxes and wanes throughout the day, says Jeter. For example, is it mostly when you eat, walk, or do certain activities?\u003c/p>\n\u003cp>\"I look for trends over time and I look at their function,\" she says.\u003c/p>\n\u003cp>\u003cstrong>Talk About Function, Not Feeling\u003c/strong>\u003c/p>\n\u003cp>Be clear about how your pain interferes with daily activities, such as getting out of bed early, getting dressed, feeling fatigued, or no longer enjoying getting out with friends, suggests Maixner.\u003c/p>\n\u003cp>Thinking about function is key, agrees Markman. He says the most accurate measurement of pain may be what it prevents patients from doing. For example, if a patient cannot chew or talk, walk, or exercise that might be more disturbing to them than the pain. Sometimes it's more useful to seek ways to \"work around the pain\" rather than \"making it go away,\" Markman says.\u003c/p>\n\u003cp>\u003cstrong>Share Treatment History\u003c/strong>\u003c/p>\n\u003cp>Describe the history of the pain, the location, how long it's been hurting and what factors seem to aggravate it, or help it get better, suggests Maixner.\u003c/p>\n\u003cp>Share other treatments you've sought, such as acupuncture, massage and certain medications, he says. \"Let the doctor know what you've done and whether it was effective.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Family history is also important, he says, especially when you consider much of an individual's pain sensitivity is inherited. If your parents were highly sensitive to pain, chances are you will be, too, he says.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Words+Matter+When+Talking+About+Pain+With+Your+Doctor&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/443544/words-matter-when-talking-about-pain-with-your-doctor","authors":["byline_futureofyou_443544"],"categories":["futureofyou_1060","futureofyou_1","futureofyou_73"],"tags":["futureofyou_259","futureofyou_61","futureofyou_379","futureofyou_218"],"collections":["futureofyou_1093"],"featImg":"futureofyou_443546","label":"source_futureofyou_443544"},"futureofyou_440006":{"type":"posts","id":"futureofyou_440006","meta":{"index":"posts_1591205157","site":"futureofyou","id":"440006","score":null,"sort":[1520291375000]},"guestAuthors":[],"slug":"does-opioid-use-lower-pain-tolerance","title":"Does Opioid Use Lower Pain Tolerance?","publishDate":1520291375,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.[contextly_sidebar id=\"JdvyNC50xeYkStqD74JGNEYfNupPuvtu\"]\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.[contextly_sidebar id=\"tYIZr9XqaiXC4XWGHMvv6XDQ7lK72GDt\"]\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"An emergency room doctor noticed that patients with a low pain threshold were regular opioid users.","status":"publish","parent":0,"modified":1520993591,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":25,"wordCount":847},"headData":{"title":"Does Opioid Use Lower Pain Tolerance? | KQED","description":"An emergency room doctor noticed that patients with a low pain threshold were regular opioid users.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Does Opioid Use Lower Pain Tolerance?","datePublished":"2018-03-05T23:09:35.000Z","dateModified":"2018-03-14T02:13:11.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"440006 https://ww2.kqed.org/futureofyou/?p=440006","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/05/does-opioid-use-lower-pain-tolerance/","disqusTitle":"Does Opioid Use Lower Pain Tolerance?","source":"Hope/Hype","nprByline":"Clayton Dalton\u003cbr />NPR Shots","nprImageAgency":"Lorenzo Gritti for NPR","nprStoryId":"586621236","nprApiLink":"http://api.npr.org/query?id=586621236&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/03/03/586621236/when-opioids-make-pain-worse?ft=nprml&f=586621236","nprRetrievedStory":"1","nprPubDate":"Mon, 05 Mar 2018 15:37:00 -0500","nprStoryDate":"Sat, 03 Mar 2018 06:00:00 -0500","nprLastModifiedDate":"Mon, 05 Mar 2018 15:37:17 -0500","path":"/futureofyou/440006/does-opioid-use-lower-pain-tolerance","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>When patients arrive in the emergency room, nearly all but those with the most minor complaints get an IV.\u003c/p>\n\u003cp>To draw blood, give medications or administer fluids, the IV is the way doctors and nurses gain access to the body. Putting one in is quick and simple, and it's no more painful than a mild bee sting.\u003c/p>\n\u003cp>Yet for some patients, this routine procedure becomes excruciating. On my shifts as an emergency physician, I began to notice a strange pattern. These hypersensitive patients often had a history of using opioids.\u003c/p>\n\u003cp>Shouldn't these patients be less susceptible to pain, instead of more so?\u003c/p>\n\u003cp>As I looked into it, I found that I was far from the first to notice the paradox of heightened pain sensitivity with opioid use. An English physician in 1870 \u003ca href=\"http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/year/2013/docId/9551\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> on morphine's tendency to \"encourage the very pain it pretends to relieve.\" In 1880, a German doctor named Rossbach \u003ca href=\"https://academic.oup.com/painmedicine/article/16/suppl_1/S32/2472483\" target=\"_blank\" rel=\"noopener\">described\u003c/a> a similar hypersensitivity to pain with opioid dependence.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>A century passed before the phenomenon received serious scientific attention. That is when American scientists \u003ca href=\"http://jpet.aspetjournals.org/content/177/3/509.long\" target=\"_blank\" rel=\"noopener\">showed\u003c/a> that rats exhibited increased sensitivity to pain after exposure to morphine, a phenomenon that became known as opioid-induced hyperalgesia.\u003c/p>\n\u003cp>By the 1990s, the \u003ca href=\"http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923441\" target=\"_blank\" rel=\"noopener\">evidence\u003c/a> of this unusual reaction in animals was strong, but whether it occurred in humans wasn't clear.\u003c/p>\n\u003cp>A hint came in 1994, when researchers \u003ca href=\"http://www.jpsmjournal.com/article/0885-3924(94)90203-8/pdf\" target=\"_blank\" rel=\"noopener\">found\u003c/a> that active heroin users were more sensitive to pain than expected. Other investigators took note, and by decade's end, a half-dozen studies had demonstrated similar results among heroin users as well as among recovering users on methadone.\u003c/p>\n\u003cp>But had these people used heroin because they had always been more sensitive to pain, perhaps from birth? The studies couldn't say.\u003c/p>\n\u003cp>In 2006, a group of Stanford researchers \u003ca href=\"http://www.jpain.org/article/S1526-5900(05)00826-6/fulltext\" target=\"_blank\" rel=\"noopener\">attempted\u003c/a> to tease apart this question. The scientists measured pain thresholds in patients with back pain before and after four months of oral morphine. The researchers found that the patients had become significantly more sensitive to pain by the study's end.\u003c/p>\n\u003cp>Another way that scientists have tried to approach the problem is by studying opioids used during surgery. Several \u003ca href=\"http://www.jcvaonline.com/article/S1053-0770(15)00049-X/fulltext\" target=\"_blank\" rel=\"noopener\">studies\u003c/a> have shown that patients randomized to receive higher doses of opioids during operations have worse pain afterward than patients who received smaller doses or a placebo. Similarly, giving short-acting opioids to healthy volunteers has been found to \u003ca href=\"https://insights.ovid.com/pubmed?pmid=14581110\" target=\"_blank\" rel=\"noopener\">heighten\u003c/a> their sensitivity to pain.\u003c/p>\n\u003cp>Taken together, these findings do seem to suggest that exposure to opioids can paradoxically increase pain, but Martin Angst, a Stanford anesthesiologist, points out a problem common to all of these studies: Were these patients just becoming tolerant to the painkillers?\u003c/p>\n\u003cp>\"Is this hyperalgesia? Is this tolerance?\" he told me. \"Nobody can say.\"\u003c/p>\n\u003cp>The questions have plagued much of the research. In pharmacology, tolerance refers to decreasing efficacy of a drug with repeated use. Not all medications are subject to this effect, but opioids certainly are. Over time, they simply don't work as well, and the original pain returns.\u003c/p>\n\u003cp>Doctors often increase the dose to counteract this effect, which works until the patient becomes tolerant to the increased amount of medicine. The result can be an upward spiral, with no clear end in sight.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But there is a drawback to this approach. If worsening pain is due to opioid-induced hyperalgesia rather than tolerance, then \"increasing the dose will only make the pain worse,\" explains Caroline Arout, a scientist at the New York State Psychiatric Institute. While tolerance is characterized by desensitization of neural pain pathways, which can be overcome by higher doses, opioid-induced hyperalgesia is the result of hypersensitization of those pathways, she says.\u003c/p>\n\u003cp>\"This could be a major factor in the opioid crisis,\" Arout says. \"People have worsening pain, and so their dose is often increased because they are thought to be tolerant.\" But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.\u003c/p>\n\u003cp>So how common is opioid-induced hyperalgesia? \"This is the million-dollar question,\" Stanford's Angst answers. \"We just don't know.\"\u003c/p>\n\u003cp>Although the current research isn't definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.\u003c/p>\n\u003cp>Pain is a critical adaptation for survival, even in the era of modern medicine. \"Think of pain in a different way, as a very useful thing to the body,\" he says. Pain in the abdomen can sometimes herald appendicitis, or some other dangerous infection. And chest pain is a cardinal symptom of heart attacks.\u003c/p>\n\u003cp>\"When we overwhelm the system with large doses of opioids — does the system fight back?\" Angst asks.\u003c/p>\n\u003cp>\"We have to accept that there are limitations to any biological system, and if you exceed them, then bad things will happen,\" he says. \"And one of those things may be opioid-induced hyperalgesia.\"\u003c/p>\n\u003chr>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>Clayton Dalton is a resident physician at Massachusetts General Hospital in Boston.\u003c/em>\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit \u003ca href=\"http://www.npr.org/\" target=\"_blank\" rel=\"noopener\">http://www.npr.org/\u003c/a>.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=When+Opioids+Make+Pain+Worse+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/440006/does-opioid-use-lower-pain-tolerance","authors":["byline_futureofyou_440006"],"programs":["futureofyou_54"],"categories":["futureofyou_1062","futureofyou_1"],"tags":["futureofyou_952","futureofyou_61","futureofyou_938","futureofyou_379","futureofyou_294"],"featImg":"futureofyou_440007","label":"source_futureofyou_440006"},"futureofyou_439905":{"type":"posts","id":"futureofyou_439905","meta":{"index":"posts_1591205157","site":"futureofyou","id":"439905","score":null,"sort":[1520023228000]},"guestAuthors":[],"slug":"blindsided-why-was-this-woman-charged-17850-for-a-urine-test","title":"Blindsided: Why Was This Woman Charged $17,850 For a Urine Test?","publishDate":1520023228,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>In her late 20s and attending college in Texas, Elizabeth Moreno suffered from debilitating back pain caused by a spinal abnormality. \"I just could not live with the pain,\" she says. \"I couldn't get dressed by myself, I couldn't walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain.\"\u003c/p>\n\u003cp>Moreno says she also tried chiropractic medicine and acupuncture, but they didn't make the pain go away. Finally, a doctor at the student health center referred her to an orthopedic specialist who performed tests and concluded a disk was blocking nerves down her legs and needed to be removed. Moreno's father, a retired Ohio doctor who had seen many failed back surgeries over his career, agreed it was the best course.[contextly_sidebar id=\"vqKuq9OjOhBxcXMb7vV8YzSosJA1vjwK\"]\u003c/p>\n\u003cp>In late 2015, Moreno had the operation in Houston, which she described as \"a complete success.\" She gave it little thought when the surgical office asked her to leave a urine sample for a drug test.\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient:\u003c/strong> Elizabeth Moreno, then 28, a student at Texas State University in San Marcos.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $17,850 for a urine test in January 2016\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> Sunset Labs LLC of Houston\u003c/p>\n\u003caside class=\"pullquote alignright\">'Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths.'\u003c/aside>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Moreno had a disk removed from her back in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up office visit in mid-January 2016, the staff asked her to leave a urine sample, which she figured was routine. In March 2017, the lab sent her a bill for $17,850 for testing her urine for a slew of drugs, including cocaine, methadone, anti-anxiety drugs and several other drugs she had never heard of.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths. Many doctors who prescribe the pills rely on the urine tests to help reduce drug abuse and keep patients with chronic pain safe. Yet the tests have become a cash cow for a burgeoning testing industry, and critics charge that unneeded and often expensive ones are sometimes ordered for profit rather than patient care. Doctors can decide whether to test patients who take opioids for short periods, such as after an operation. Moreno's surgeon would not discuss her urine test — why he ordered it and why the sample was tested for so many substances.\u003c/p>\n\u003cp>Three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear of the lab's prices. They said these tests rarely cost more than $200, and typically much less, depending on the complexity and the technology used. Some doctors' offices use a simple cup test, which can detect several classes of drugs on the spot and could be purchased for about $10. Bills can climb higher when labs run tests to detect the quantity of specific drugs and bill for each one, as the lab did here.[contextly_sidebar id=\"mnWbYp5KSicKpyA8MvvQPncVSL8Nauim\"]\u003c/p>\n\u003cp>The experts said the lab's prices for individual tests were excessive, such as charging $1,700 to check for amphetamines or $425 to identify phencyclidine, an illegal hallucinogenic drug also known as PCP. They also criticized a charge of $850 for two tests to verify that her urine sample had not been adulterated or tampered with.\u003c/p>\n\u003cp>Moreno's insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the bill, arguing that the lab was out of network and thus not covered. Had it chipped in, it would have covered the service at $100.92, according to an \u003ca href=\"https://www.documentcloud.org/documents/4353248-Blue-Cross-Blue-Shield-EOB-for-Urine-Drug-Screen.html\">explanation of benefits\u003c/a> the insurance company sent to Moreno.\u003c/p>\n\u003cp>Sunset Labs says its list prices were \"in line\" with its competitors in the area. It also said doctors treating pain agree extensive urine testing is \"the best course of action\" and that a lab \"is not in the position\" to question tests ordered by a doctor.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Fearing damage to his daughter's credit rating, Moreno's father, Dr. Paul Davis, paid the lab $5,000 to settle the bill in April 2017. A retired doctor, he also has filed a formal complaint about the bill with the Texas attorney general's office, accusing the lab of \"price gouging of staggering proportions.\" The lab's attorney said he was not aware of the complaint. A Texas attorney general's spokesperson confirmed to KHN that the office had received complaints about the lab but declined further comment.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> When a physician asks for a urine or blood sample, always ask what it's for. Insist that it be sent to a lab in your insurance network.\u003c/p>\n\u003cdiv class=\"hr\">\n\u003chr>\n\u003c/div>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is the debut of a monthly feature from Kaiser Health News and NPR that will dissect and explain real medical bills to shed light on prices in U.S. health care and to help patients learn how to be more active in managing costs. Do you have a medical bill that you'd like us to see and scrutinize? Submit \u003c/em>\u003ca href=\"http://www.npr.org/sections/health-shots/2018/02/13/585549568/share-your-medical-bill-with-us\">it here and tell us\u003c/a>\u003cem> the story behind it.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Urine tests have exploded amid alarm over opioid abuse and critics say the tests have become a cash cow.","status":"publish","parent":0,"modified":1520023228,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":871},"headData":{"title":"Blindsided: Why Was This Woman Charged $17,850 For a Urine Test? | KQED","description":"Urine tests have exploded amid alarm over opioid abuse and critics say the tests have become a cash cow.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Blindsided: Why Was This Woman Charged $17,850 For a Urine Test?","datePublished":"2018-03-02T20:40:28.000Z","dateModified":"2018-03-02T20:40:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"439905 https://ww2.kqed.org/futureofyou/?p=439905","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/03/02/blindsided-why-was-this-woman-charged-17850-for-a-urine-test/","disqusTitle":"Blindsided: Why Was This Woman Charged $17,850 For a Urine Test?","nprByline":"Fred Schulte\u003cbr />NPR Shots","path":"/futureofyou/439905/blindsided-why-was-this-woman-charged-17850-for-a-urine-test","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>In her late 20s and attending college in Texas, Elizabeth Moreno suffered from debilitating back pain caused by a spinal abnormality. \"I just could not live with the pain,\" she says. \"I couldn't get dressed by myself, I couldn't walk across my house, let alone to class, and nothing, no drug that had been prescribed to me, even dulled the pain.\"\u003c/p>\n\u003cp>Moreno says she also tried chiropractic medicine and acupuncture, but they didn't make the pain go away. Finally, a doctor at the student health center referred her to an orthopedic specialist who performed tests and concluded a disk was blocking nerves down her legs and needed to be removed. Moreno's father, a retired Ohio doctor who had seen many failed back surgeries over his career, agreed it was the best course.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In late 2015, Moreno had the operation in Houston, which she described as \"a complete success.\" She gave it little thought when the surgical office asked her to leave a urine sample for a drug test.\u003c/p>\n\u003cp>Then the bill came.\u003c/p>\n\u003cp>\u003cstrong>Patient:\u003c/strong> Elizabeth Moreno, then 28, a student at Texas State University in San Marcos.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Total bill:\u003c/strong> $17,850 for a urine test in January 2016\u003c/p>\n\u003cp>\u003cstrong>Service provider:\u003c/strong> Sunset Labs LLC of Houston\u003c/p>\n\u003caside class=\"pullquote alignright\">'Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths.'\u003c/aside>\n\u003cp>\u003cstrong>Medical treatment:\u003c/strong> Moreno had a disk removed from her back in December 2015. Her surgeon prescribed an opioid painkiller, hydrocodone. At a follow-up office visit in mid-January 2016, the staff asked her to leave a urine sample, which she figured was routine. In March 2017, the lab sent her a bill for $17,850 for testing her urine for a slew of drugs, including cocaine, methadone, anti-anxiety drugs and several other drugs she had never heard of.\u003c/p>\n\u003cp>\u003cstrong>What gives:\u003c/strong> Urine drug testing has exploded over the past decade amid alarm over rising opioid overdose deaths. Many doctors who prescribe the pills rely on the urine tests to help reduce drug abuse and keep patients with chronic pain safe. Yet the tests have become a cash cow for a burgeoning testing industry, and critics charge that unneeded and often expensive ones are sometimes ordered for profit rather than patient care. Doctors can decide whether to test patients who take opioids for short periods, such as after an operation. Moreno's surgeon would not discuss her urine test — why he ordered it and why the sample was tested for so many substances.\u003c/p>\n\u003cp>Three experts contacted by Kaiser Health News questioned the need for such extensive testing and were shocked to hear of the lab's prices. They said these tests rarely cost more than $200, and typically much less, depending on the complexity and the technology used. Some doctors' offices use a simple cup test, which can detect several classes of drugs on the spot and could be purchased for about $10. Bills can climb higher when labs run tests to detect the quantity of specific drugs and bill for each one, as the lab did here.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The experts said the lab's prices for individual tests were excessive, such as charging $1,700 to check for amphetamines or $425 to identify phencyclidine, an illegal hallucinogenic drug also known as PCP. They also criticized a charge of $850 for two tests to verify that her urine sample had not been adulterated or tampered with.\u003c/p>\n\u003cp>Moreno's insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the bill, arguing that the lab was out of network and thus not covered. Had it chipped in, it would have covered the service at $100.92, according to an \u003ca href=\"https://www.documentcloud.org/documents/4353248-Blue-Cross-Blue-Shield-EOB-for-Urine-Drug-Screen.html\">explanation of benefits\u003c/a> the insurance company sent to Moreno.\u003c/p>\n\u003cp>Sunset Labs says its list prices were \"in line\" with its competitors in the area. It also said doctors treating pain agree extensive urine testing is \"the best course of action\" and that a lab \"is not in the position\" to question tests ordered by a doctor.\u003c/p>\n\u003cp>\u003cstrong>Resolution:\u003c/strong> Fearing damage to his daughter's credit rating, Moreno's father, Dr. Paul Davis, paid the lab $5,000 to settle the bill in April 2017. A retired doctor, he also has filed a formal complaint about the bill with the Texas attorney general's office, accusing the lab of \"price gouging of staggering proportions.\" The lab's attorney said he was not aware of the complaint. A Texas attorney general's spokesperson confirmed to KHN that the office had received complaints about the lab but declined further comment.\u003c/p>\n\u003cp>\u003cstrong>The takeaway:\u003c/strong> When a physician asks for a urine or blood sample, always ask what it's for. Insist that it be sent to a lab in your insurance network.\u003c/p>\n\u003cdiv class=\"hr\">\n\u003chr>\n\u003c/div>\n\u003cp>\u003c/p>\n\u003cp>\u003cem>This is the debut of a monthly feature from Kaiser Health News and NPR that will dissect and explain real medical bills to shed light on prices in U.S. health care and to help patients learn how to be more active in managing costs. Do you have a medical bill that you'd like us to see and scrutinize? Submit \u003c/em>\u003ca href=\"http://www.npr.org/sections/health-shots/2018/02/13/585549568/share-your-medical-bill-with-us\">it here and tell us\u003c/a>\u003cem> the story behind it.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/439905/blindsided-why-was-this-woman-charged-17850-for-a-urine-test","authors":["byline_futureofyou_439905"],"categories":["futureofyou_452","futureofyou_1"],"tags":["futureofyou_190","futureofyou_552","futureofyou_61","futureofyou_419","futureofyou_938","futureofyou_379"],"featImg":"futureofyou_439907","label":"futureofyou"},"futureofyou_437823":{"type":"posts","id":"futureofyou_437823","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437823","score":null,"sort":[1513756867000]},"guestAuthors":[],"slug":"how-babies-experience-pain-is-a-mystery-and-thats-a-problem","title":"How Babies Experience Pain Is a Mystery, and That's a Problem","publishDate":1513756867,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Before the 1980s, clinicians actually performed surgery on newborns \u003ca href=\"https://gizmodo.com/why-are-so-many-newborns-still-being-denied-pain-relief-1755495866\">without giving them anaesthetics or pain medications\u003c/a>. This wasn’t because they thought babies were completely incapable of feeling pain. But they didn’t know how much pain the newborns could experience and feared that the medications may be too dangerous to warrant use.\u003c/p>\n\u003caside class=\"pullquote alignright\">We may be underestimating how much pain babies feel when they are under stress.\u003c/aside>\n\u003cp>Luckily we are better informed today. As babies can’t tell us how much pain they are in, scientists have invented several ingenious methods to try and work out what they are feeling. But there’s still a remarkable amount we don’t understand. And our new study, \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">published in \u003cem>Current Biology\u003c/em>\u003c/a>, shows that we may be underestimating how much pain babies feel when they are under stress.\u003c/p>\n\u003cp>The reason progress has been relatively slow is that there was for a long time no agreed method for reliably measuring babies’ pain perception. It’s only in the last few decades scientists have made increasing efforts to do this – and the results may be applicable to other people who are unable to communicate too.\u003c/p>\n\u003cp>The first clues came from animal models in the early 1980s. These showed that the structural and functional connections within the nervous system required to perceive a painful event \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15995722\">are present from birth\u003c/a>. However, we still do not know whether these connections are sufficiently mature for infants to experience pain in quite the same way as adults.\u003c/p>\n\u003cp>[contextly_sidebar id=\"BJ3pqNXoimP8bsBlSfB7ESqz7mKXi3rn\"]At the same time, clinical investigators started exploring ways of measuring pain in human infants. Following a painful procedure, such as the heel stick used for blood tests (much like a finger prick used for adult blood tests), \u003ca href=\"http://europepmc.org/abstract/med/9409099\">infants show several significant responses\u003c/a>. These range from physiological (changes in heart rate or breathing) and hormonal (release of the “stress hormone” cortisol) to behavioural (crying or grimacing).\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Extensive research in this area suggested that infant pain should be evaluated with a combination of these measures, leading to the development of neonatal clinical pain scoring systems, such as the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8722730\">Premature Infant Pain Profile\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Pain in the brain\u003c/strong>\u003cbr>\nAnother big advance in the field came from the Fitzgerald lab here at University College London, which moved away from solely using observations of behavior and physiological responses to measure pain. Instead, it turned to the brain. We know that the perception of pain is generated by the central nervous system, so these researchers aimed to directly measure the activity of neurons (brain cells) that are responsible for the sensation of pain.\u003c/p>\n\u003cp>To do this, they used non-invasive measures like \u003ca href=\"http://www.uhs.nhs.uk/OurServices/Brainspineandneuromuscular/Clinicalneurophysiology/Electromyography.aspx\">electromyography\u003c/a>(EMG) and \u003ca href=\"https://www.nhs.uk/conditions/electroencephalogram/\">electroencephalography\u003c/a> (EEG), which measure the electrical activity generated by muscles and brain cells, following a painful event. This method has the advantage of being both objective and quantitative, as it does not depend on observational scoring.\u003c/p>\n\u003cp>These studies confirmed that infants do process pain in the brain, but that they differ in their experiences with age. First, the lab recorded spinal reflexes – such as the withdrawal reflex, which is intended to protect the body from damaging stimuli – and found that premature infants are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8159446\">more sensitive to sensory stimulation\u003c/a> than older infants. They subjected babies to repeated non-painful touches, and found that younger infants moved their limbs following lighter touches than older infants. In fact, the older infants got used to the repeated touches and eventually stopped moving their limbs.\u003c/p>\n\u003cp>[contextly_sidebar id=\"t4QP70bYEJJe0X6Osa1q4RPSKJ8fEsXS\"]They also found that premature infants responded to both painful and non-painful touch with whole body movements. In older babies (at term age, around 40 weeks) this matured into more a purposeful withdrawal of the stimulated limb, \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076470\">becoming more specific to pain\u003c/a> rather than any touch.\u003c/p>\n\u003cp>An important next step was to record activity in the brain, which is where pain perception occurs. They did this with EEG, which uses electrodes placed on the scalp to track and record brain waves. They found that premature infants exhibited large bursts of brain activity which, as with early reflexes, are not specific to pain (a simple tap could produce a similar effect as a heel prick). Towards normal term age (a few weeks prior), infants were \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21906948\">more likely to show a clear pain-specific brainwave\u003c/a>similar to that seen in adults.\u003c/p>\n\u003cp>However, while this was a direct read out of what was happening in the nervous system after a painful event, you shouldn’t assume it was a direct reflection of what the baby was feeling. This is because the feeling of pain requires an \u003ca href=\"https://theconversation.com/pain-is-more-than-a-physical-process-now-a-study-in-mice-suggests-it-may-even-be-socially-transferable-67479\">emotional component as well as a sensory part\u003c/a>, and although we can measure the sensory aspect, we can not measure or make assumptions about the emotional processing in a newborn.\u003c/p>\n\u003cp>\u003cstrong>Stress and pain\u003c/strong>\u003cbr>\nIn our latest research, my colleagues and I at the Fitzgerald lab focused on stress and pain. Many infants experience physiological stress as a result of necessary clinical procedures. For example, hospitalized babies often require several painful procedures a day as part of their care, and those who do not will likely experience events such as being weighed or loud noises (alarms) as stressful.\u003c/p>\n\u003cp>For the first time, we measured both pain and stress at the same time as a single, clinically required blood test. In 56 hospitalised newborns, the pain-related brain activity and behavioural response was measured following the blood test, while the babies’ background level of stress was measured using the concentration of a stress hormone (cortisol) in the saliva and heart rate patterns.\u003c/p>\n\u003cp>[contextly_sidebar id=\"0wjAsSlSUcsEOQMQ6W9PhNBBMGzmlLPs\"]The results show that for babies who are not stressed, a painful procedure \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">will often result\u003c/a> in a coordinated increase in brain activity and behaviour, in the form of facial expressions. Babies who are more stressed have an even larger response in the brain following a painful procedure, but, importantly, this is no longer matched by changes in behaviour. In other words, a stressed baby may have strong pain-related activity in their brain, but you could not tell that from simply observing their behaviour.\u003c/p>\n\u003cp>Since increased levels of stress can increase the amount of pain-related brain activity, it is clear that we should monitor and control the stress levels of hospitalized babies. Stressed babies may not seem to respond to pain although their brain is still processing it. The phenomenon has been seen in premature babies who sometimes “tune out” and become unresponsive when they are overwhelmed. But that doesn’t mean they are not experiencing something. Importantly, this means that doctors and nurses may underestimate their pain.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Given its huge importance, it may seem surprising that we know so little about what newborns actually feel. Thankfully, research is unravelling the mystery with impressive speed.\u003c/p>\n\n","blocks":[],"excerpt":"For a long time, we had no way of measuring babies’ pain.","status":"publish","parent":0,"modified":1513635954,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":19,"wordCount":1152},"headData":{"title":"How Babies Experience Pain Is a Mystery, and That's a Problem | KQED","description":"For a long time, we had no way of measuring babies’ pain.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"How Babies Experience Pain Is a Mystery, and That's a Problem","datePublished":"2017-12-20T08:01:07.000Z","dateModified":"2017-12-18T22:25:54.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437823 https://ww2.kqed.org/futureofyou/?p=437823","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/12/20/how-babies-experience-pain-is-a-mystery-and-thats-a-problem/","disqusTitle":"How Babies Experience Pain Is a Mystery, and That's a Problem","nprByline":"Laura Jones\u003c/br>The Conversation","path":"/futureofyou/437823/how-babies-experience-pain-is-a-mystery-and-thats-a-problem","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before the 1980s, clinicians actually performed surgery on newborns \u003ca href=\"https://gizmodo.com/why-are-so-many-newborns-still-being-denied-pain-relief-1755495866\">without giving them anaesthetics or pain medications\u003c/a>. This wasn’t because they thought babies were completely incapable of feeling pain. But they didn’t know how much pain the newborns could experience and feared that the medications may be too dangerous to warrant use.\u003c/p>\n\u003caside class=\"pullquote alignright\">We may be underestimating how much pain babies feel when they are under stress.\u003c/aside>\n\u003cp>Luckily we are better informed today. As babies can’t tell us how much pain they are in, scientists have invented several ingenious methods to try and work out what they are feeling. But there’s still a remarkable amount we don’t understand. And our new study, \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">published in \u003cem>Current Biology\u003c/em>\u003c/a>, shows that we may be underestimating how much pain babies feel when they are under stress.\u003c/p>\n\u003cp>The reason progress has been relatively slow is that there was for a long time no agreed method for reliably measuring babies’ pain perception. It’s only in the last few decades scientists have made increasing efforts to do this – and the results may be applicable to other people who are unable to communicate too.\u003c/p>\n\u003cp>The first clues came from animal models in the early 1980s. These showed that the structural and functional connections within the nervous system required to perceive a painful event \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15995722\">are present from birth\u003c/a>. However, we still do not know whether these connections are sufficiently mature for infants to experience pain in quite the same way as adults.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>At the same time, clinical investigators started exploring ways of measuring pain in human infants. Following a painful procedure, such as the heel stick used for blood tests (much like a finger prick used for adult blood tests), \u003ca href=\"http://europepmc.org/abstract/med/9409099\">infants show several significant responses\u003c/a>. These range from physiological (changes in heart rate or breathing) and hormonal (release of the “stress hormone” cortisol) to behavioural (crying or grimacing).\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Extensive research in this area suggested that infant pain should be evaluated with a combination of these measures, leading to the development of neonatal clinical pain scoring systems, such as the \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8722730\">Premature Infant Pain Profile\u003c/a>.\u003c/p>\n\u003cp>\u003cstrong>Pain in the brain\u003c/strong>\u003cbr>\nAnother big advance in the field came from the Fitzgerald lab here at University College London, which moved away from solely using observations of behavior and physiological responses to measure pain. Instead, it turned to the brain. We know that the perception of pain is generated by the central nervous system, so these researchers aimed to directly measure the activity of neurons (brain cells) that are responsible for the sensation of pain.\u003c/p>\n\u003cp>To do this, they used non-invasive measures like \u003ca href=\"http://www.uhs.nhs.uk/OurServices/Brainspineandneuromuscular/Clinicalneurophysiology/Electromyography.aspx\">electromyography\u003c/a>(EMG) and \u003ca href=\"https://www.nhs.uk/conditions/electroencephalogram/\">electroencephalography\u003c/a> (EEG), which measure the electrical activity generated by muscles and brain cells, following a painful event. This method has the advantage of being both objective and quantitative, as it does not depend on observational scoring.\u003c/p>\n\u003cp>These studies confirmed that infants do process pain in the brain, but that they differ in their experiences with age. First, the lab recorded spinal reflexes – such as the withdrawal reflex, which is intended to protect the body from damaging stimuli – and found that premature infants are \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/8159446\">more sensitive to sensory stimulation\u003c/a> than older infants. They subjected babies to repeated non-painful touches, and found that younger infants moved their limbs following lighter touches than older infants. In fact, the older infants got used to the repeated touches and eventually stopped moving their limbs.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>They also found that premature infants responded to both painful and non-painful touch with whole body movements. In older babies (at term age, around 40 weeks) this matured into more a purposeful withdrawal of the stimulated limb, \u003ca href=\"http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0076470\">becoming more specific to pain\u003c/a> rather than any touch.\u003c/p>\n\u003cp>An important next step was to record activity in the brain, which is where pain perception occurs. They did this with EEG, which uses electrodes placed on the scalp to track and record brain waves. They found that premature infants exhibited large bursts of brain activity which, as with early reflexes, are not specific to pain (a simple tap could produce a similar effect as a heel prick). Towards normal term age (a few weeks prior), infants were \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/21906948\">more likely to show a clear pain-specific brainwave\u003c/a>similar to that seen in adults.\u003c/p>\n\u003cp>However, while this was a direct read out of what was happening in the nervous system after a painful event, you shouldn’t assume it was a direct reflection of what the baby was feeling. This is because the feeling of pain requires an \u003ca href=\"https://theconversation.com/pain-is-more-than-a-physical-process-now-a-study-in-mice-suggests-it-may-even-be-socially-transferable-67479\">emotional component as well as a sensory part\u003c/a>, and although we can measure the sensory aspect, we can not measure or make assumptions about the emotional processing in a newborn.\u003c/p>\n\u003cp>\u003cstrong>Stress and pain\u003c/strong>\u003cbr>\nIn our latest research, my colleagues and I at the Fitzgerald lab focused on stress and pain. Many infants experience physiological stress as a result of necessary clinical procedures. For example, hospitalized babies often require several painful procedures a day as part of their care, and those who do not will likely experience events such as being weighed or loud noises (alarms) as stressful.\u003c/p>\n\u003cp>For the first time, we measured both pain and stress at the same time as a single, clinically required blood test. In 56 hospitalised newborns, the pain-related brain activity and behavioural response was measured following the blood test, while the babies’ background level of stress was measured using the concentration of a stress hormone (cortisol) in the saliva and heart rate patterns.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The results show that for babies who are not stressed, a painful procedure \u003ca href=\"http://www.cell.com/current-biology/fulltext/S0960-9822(17)31400-8\">will often result\u003c/a> in a coordinated increase in brain activity and behaviour, in the form of facial expressions. Babies who are more stressed have an even larger response in the brain following a painful procedure, but, importantly, this is no longer matched by changes in behaviour. In other words, a stressed baby may have strong pain-related activity in their brain, but you could not tell that from simply observing their behaviour.\u003c/p>\n\u003cp>Since increased levels of stress can increase the amount of pain-related brain activity, it is clear that we should monitor and control the stress levels of hospitalized babies. Stressed babies may not seem to respond to pain although their brain is still processing it. The phenomenon has been seen in premature babies who sometimes “tune out” and become unresponsive when they are overwhelmed. But that doesn’t mean they are not experiencing something. Importantly, this means that doctors and nurses may underestimate their pain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Given its huge importance, it may seem surprising that we know so little about what newborns actually feel. Thankfully, research is unravelling the mystery with impressive speed.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437823/how-babies-experience-pain-is-a-mystery-and-thats-a-problem","authors":["byline_futureofyou_437823"],"categories":["futureofyou_1"],"tags":["futureofyou_631","futureofyou_379"],"featImg":"futureofyou_437824","label":"futureofyou"},"futureofyou_437432":{"type":"posts","id":"futureofyou_437432","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437432","score":null,"sort":[1512547305000]},"guestAuthors":[],"slug":"tylenol-may-help-ease-the-pain-of-hurt-feelings","title":"Tylenol May Help Ease The Pain Of Hurt Feelings","publishDate":1512547305,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Nobody likes the feeling of being left out, and when it happens, we tend to describe these experiences with the same words we use to talk about the physical pain of, say, a toothache.\u003c/p>\n\u003cp>\"People say, 'Oh, that hurts,' \" says \u003ca href=\"https://psychology.as.uky.edu/users/njdewa2\">Nathan DeWall\u003c/a>, a professor of psychology at the University of Kentucky.\u003c/p>\n\u003caside class=\"pullquote alignright\">Pain pills seemed to dim activity in regions of the brain involved in processing social pain.\u003c/aside>\n\u003cp>DeWall and his colleagues were curious about the crossover between physical pain and emotional pain, so they began a series of experiments several years back.\u003c/p>\n\u003cp>In one study, they found that acetaminophen (the active ingredient in Tylenol) seemed to reduce the sting of rejection that people experienced after they were excluded from a virtual ball-tossing game.\u003c/p>\n\u003cp>The pain pills seemed to dim activity in regions of the brain involved in processing social pain, according to brain imaging. \"People knew they were getting left out [of the game], it just didn't bother them as much,\" DeWall explains.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As part of the study, participants were given either acetaminophen or a placebo for three weeks. None of the participants knew which one they were given. Each evening, participants completed a \u003ca href=\"http://www.midss.org/content/hurt-feelings-scale\">Hurt Feelings Scale\u003c/a>, designed as a standardized measure of emotional pain. They were asked to rank themselves on statements such as: \"Today, being teased hurt my feelings.\" It turned out that the pain medicine reduced reports of social pain.\u003c/p>\n\u003cp>[contextly_sidebar id=\"I1v1EslvGhTVuAuQUjZcfhFYZvYaKLVz\"]The emotional dampening documented in these experiments is not huge, but it appears significant enough to nudge people into a less-sensitive emotional state.\u003c/p>\n\u003cp>Since that study was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20548058\">published\u003c/a> in \u003cem>Psychological Science\u003c/em> back in 2010, a body of evidence has accumulated that points to a range of subtle psychological effects attributed to acetaminophen. For instance, a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25862546?dopt=Abstract\">published\u003c/a> in 2015 found that the pain medicine seems to diminish our emotional highs and lows. Another study pointed to a \u003ca href=\"https://academic.oup.com/scan/article/11/9/1345/2224135\">reduction in empathy \u003c/a>among people taking acetaminophen.\u003c/p>\n\u003cp>And a \u003ca href=\"http://journals.sagepub.com/doi/pdf/10.1177/2167702617731374\">study \u003c/a>published in October suggests the drug may dampen the tendency to distrust in people with borderline personality disorder.\u003c/p>\n\u003cp>\"Through reducing our attention to the outside world, acetaminophen appears to nudge us into a more psychologically insulated state,\" says \u003ca href=\"https://psych.ubc.ca/persons/todd-handy/\">Todd Handy\u003c/a>, a psychology professor at the University of British Columbia in Canada.\u003c/p>\n\u003cp>Handy also studies mind-wandering. In one recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884318/\">experiment\u003c/a>, published in \u003cem>Social Cognitive and Affective Neuroscience\u003c/em>, he and his collaborators found that acetaminophen seemed to make people care less about the mistakes they made when they zoned out. During the experiment, participants were asked to sit in front of a computer screen and complete a repetitive task. \"Once every couple seconds, something flashes on the screen and you have to hit a button,\" Handy explains. \"We try to bore people so they will actually mind wander.\"\u003c/p>\n\u003cp>Handy found that people taking the painkiller mind-wandered at about the same rate as people on the placebo, but their reactions were different. \"When people on Tylenol mind-wander, they're shutting stuff out more effectively than people who aren't on Tylenol.\"\u003c/p>\n\u003cp>Now, whether these subtle effects are good or bad depends on the context. \u003ca href=\"http://faculty.psy.ohio-state.edu/way/\">Baldwin Way\u003c/a>, a professor of psychology at Ohio State University who has also published on the effects of acetaminophen, says that in some instances, the emotional dampening could work against us.\u003c/p>\n\u003cp>\"If you're speaking to your romantic partner and their emotions are blunted,\" Way says, \"and they react blunted and less emotional, that can probably have a negative effect.\"\u003c/p>\n\u003cp>On the other hand, say you're anxious about an upcoming medical procedure, social situation or a job interview, \"maybe having blunted emotions can help you perform more effectively,\" Way says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But no one is recommending that people start popping the over-the-counter medication regularly to protect against social pain. Though it's among the most common drugs in Americans' medicine cabinets, it can be \u003ca href=\"https://medlineplus.gov/druginfo/meds/a681004.html\">risky\u003c/a>. Taking acetaminophen can cause gastrointestinal problems and taking large doses increases the risk of liver failure. People often don't realize that acetaminophen is an ingredient in many different products, so they can inadvertently take too much.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Tylenol+May+Help+Ease+The+Pain+Of+Hurt+Feelings&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"Acetaminophen, the world's most popular painkiller, doesn't just dull physical aches, it also has subtle psychological effects, researchers say. But blunting emotions isn't always a good thing.","status":"publish","parent":0,"modified":1512426010,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":18,"wordCount":697},"headData":{"title":"Tylenol May Help Ease The Pain Of Hurt Feelings | KQED","description":"Acetaminophen, the world's most popular painkiller, doesn't just dull physical aches, it also has subtle psychological effects, researchers say. But blunting emotions isn't always a good thing.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Tylenol May Help Ease The Pain Of Hurt Feelings","datePublished":"2017-12-06T08:01:45.000Z","dateModified":"2017-12-04T22:20:10.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437432 https://ww2.kqed.org/futureofyou/?p=437432","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/12/06/tylenol-may-help-ease-the-pain-of-hurt-feelings/","disqusTitle":"Tylenol May Help Ease The Pain Of Hurt Feelings","nprByline":"Allison Aubrey\u003c/br>NPR Shots","nprImageAgency":"Kristen Uroda for NPR","nprStoryId":"567762087","nprApiLink":"http://api.npr.org/query?id=567762087&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2017/12/04/567762087/tylenol-may-help-ease-the-pain-of-hurt-feelings?ft=nprml&f=567762087","nprRetrievedStory":"1","nprPubDate":"Mon, 04 Dec 2017 08:09:00 -0500","nprStoryDate":"Mon, 04 Dec 2017 05:14:00 -0500","nprLastModifiedDate":"Mon, 04 Dec 2017 08:22:22 -0500","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2017/12/20171204_me_tylenol_may_help_ease_the_pain_of_hurt_feelings.mp3?orgId=1&topicId=1128&d=226&p=3&story=567762087&ft=nprml&f=567762087","nprAudioM3u":"http://api.npr.org/m3u/1568255260-6bb5bc.m3u?orgId=1&topicId=1128&d=226&p=3&story=567762087&ft=nprml&f=567762087","path":"/futureofyou/437432/tylenol-may-help-ease-the-pain-of-hurt-feelings","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2017/12/20171204_me_tylenol_may_help_ease_the_pain_of_hurt_feelings.mp3?orgId=1&topicId=1128&d=226&p=3&story=567762087&ft=nprml&f=567762087","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Nobody likes the feeling of being left out, and when it happens, we tend to describe these experiences with the same words we use to talk about the physical pain of, say, a toothache.\u003c/p>\n\u003cp>\"People say, 'Oh, that hurts,' \" says \u003ca href=\"https://psychology.as.uky.edu/users/njdewa2\">Nathan DeWall\u003c/a>, a professor of psychology at the University of Kentucky.\u003c/p>\n\u003caside class=\"pullquote alignright\">Pain pills seemed to dim activity in regions of the brain involved in processing social pain.\u003c/aside>\n\u003cp>DeWall and his colleagues were curious about the crossover between physical pain and emotional pain, so they began a series of experiments several years back.\u003c/p>\n\u003cp>In one study, they found that acetaminophen (the active ingredient in Tylenol) seemed to reduce the sting of rejection that people experienced after they were excluded from a virtual ball-tossing game.\u003c/p>\n\u003cp>The pain pills seemed to dim activity in regions of the brain involved in processing social pain, according to brain imaging. \"People knew they were getting left out [of the game], it just didn't bother them as much,\" DeWall explains.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As part of the study, participants were given either acetaminophen or a placebo for three weeks. None of the participants knew which one they were given. Each evening, participants completed a \u003ca href=\"http://www.midss.org/content/hurt-feelings-scale\">Hurt Feelings Scale\u003c/a>, designed as a standardized measure of emotional pain. They were asked to rank themselves on statements such as: \"Today, being teased hurt my feelings.\" It turned out that the pain medicine reduced reports of social pain.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The emotional dampening documented in these experiments is not huge, but it appears significant enough to nudge people into a less-sensitive emotional state.\u003c/p>\n\u003cp>Since that study was \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/20548058\">published\u003c/a> in \u003cem>Psychological Science\u003c/em> back in 2010, a body of evidence has accumulated that points to a range of subtle psychological effects attributed to acetaminophen. For instance, a study \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/25862546?dopt=Abstract\">published\u003c/a> in 2015 found that the pain medicine seems to diminish our emotional highs and lows. Another study pointed to a \u003ca href=\"https://academic.oup.com/scan/article/11/9/1345/2224135\">reduction in empathy \u003c/a>among people taking acetaminophen.\u003c/p>\n\u003cp>And a \u003ca href=\"http://journals.sagepub.com/doi/pdf/10.1177/2167702617731374\">study \u003c/a>published in October suggests the drug may dampen the tendency to distrust in people with borderline personality disorder.\u003c/p>\n\u003cp>\"Through reducing our attention to the outside world, acetaminophen appears to nudge us into a more psychologically insulated state,\" says \u003ca href=\"https://psych.ubc.ca/persons/todd-handy/\">Todd Handy\u003c/a>, a psychology professor at the University of British Columbia in Canada.\u003c/p>\n\u003cp>Handy also studies mind-wandering. In one recent \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884318/\">experiment\u003c/a>, published in \u003cem>Social Cognitive and Affective Neuroscience\u003c/em>, he and his collaborators found that acetaminophen seemed to make people care less about the mistakes they made when they zoned out. During the experiment, participants were asked to sit in front of a computer screen and complete a repetitive task. \"Once every couple seconds, something flashes on the screen and you have to hit a button,\" Handy explains. \"We try to bore people so they will actually mind wander.\"\u003c/p>\n\u003cp>Handy found that people taking the painkiller mind-wandered at about the same rate as people on the placebo, but their reactions were different. \"When people on Tylenol mind-wander, they're shutting stuff out more effectively than people who aren't on Tylenol.\"\u003c/p>\n\u003cp>Now, whether these subtle effects are good or bad depends on the context. \u003ca href=\"http://faculty.psy.ohio-state.edu/way/\">Baldwin Way\u003c/a>, a professor of psychology at Ohio State University who has also published on the effects of acetaminophen, says that in some instances, the emotional dampening could work against us.\u003c/p>\n\u003cp>\"If you're speaking to your romantic partner and their emotions are blunted,\" Way says, \"and they react blunted and less emotional, that can probably have a negative effect.\"\u003c/p>\n\u003cp>On the other hand, say you're anxious about an upcoming medical procedure, social situation or a job interview, \"maybe having blunted emotions can help you perform more effectively,\" Way says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>But no one is recommending that people start popping the over-the-counter medication regularly to protect against social pain. Though it's among the most common drugs in Americans' medicine cabinets, it can be \u003ca href=\"https://medlineplus.gov/druginfo/meds/a681004.html\">risky\u003c/a>. Taking acetaminophen can cause gastrointestinal problems and taking large doses increases the risk of liver failure. People often don't realize that acetaminophen is an ingredient in many different products, so they can inadvertently take too much.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2017 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Tylenol+May+Help+Ease+The+Pain+Of+Hurt+Feelings&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437432/tylenol-may-help-ease-the-pain-of-hurt-feelings","authors":["byline_futureofyou_437432"],"categories":["futureofyou_1"],"tags":["futureofyou_205","futureofyou_379","futureofyou_381"],"featImg":"futureofyou_437433","label":"futureofyou"},"futureofyou_437388":{"type":"posts","id":"futureofyou_437388","meta":{"index":"posts_1591205157","site":"futureofyou","id":"437388","score":null,"sort":[1512028896000]},"guestAuthors":[],"slug":"doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills","title":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills","publishDate":1512028896,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>[contextly_sidebar id=\"IKKSKEYlRZSZtDmHEy3bAWPqrZ5UtBdX\"]But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n","blocks":[],"excerpt":"Following minor surgery, KHN’s consumer columnist sees how easily doctors offer pain pills, fueling epidemic of opioid addiction.","status":"publish","parent":0,"modified":1512069043,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":27,"wordCount":1141},"headData":{"title":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills | KQED","description":"Following minor surgery, KHN’s consumer columnist sees how easily doctors offer pain pills, fueling epidemic of opioid addiction.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills","datePublished":"2017-11-30T08:01:36.000Z","dateModified":"2017-11-30T19:10:43.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"437388 https://ww2.kqed.org/futureofyou/?p=437388","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/11/30/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills/","disqusTitle":"Doctor’s Rx For a Stiff Knee: A Prescription For 90 Percocet Pills","nprByline":"Michelle Andrews\u003c/br>Kaiser Health News","path":"/futureofyou/437388/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>I recently hobbled to the drugstore to pick up painkillers after minor outpatient knee surgery, only to discover that the pharmacist hadn’t yet filled the prescription. My doctor’s order of 90 generic Percocet exceeded the number my insurer would approve, he said. I left a short time later with a bottle containing a smaller number.\u003c/p>\n\u003cp>When I got home and opened the package to take a pill, I discovered that there were 42 inside.\u003c/p>\n\u003cp>Talk about using a shotgun to kill a mosquito. I was stiff and sore after the orthopedist fished out a couple of loose pieces of bone and cartilage from my left knee. But on a pain scale of 0 to 10, I was a 4, tops. I probably could have gotten by with a much less potent drug than a painkiller like \u003ca href=\"https://www.webmd.com/pain-management/guide/narcotic-pain-medications#1\" target=\"_blank\" rel=\"noopener\">Percocet\u003c/a>, which contains a combination of the opioid oxycodone and the pain reliever acetaminophen, the active ingredient found in over-the-counter Tylenol.\u003c/p>\n\u003caside class=\"pullquote alignright\">As public health officials grapple with how to slow the growing opioid epidemic — which claims 91 lives each day, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/aside>\n\u003cp>When I went in for my follow-up appointment a week after surgery, I asked my orthopedist about those 90 pills.\u003c/p>\n\u003cp>“If you had real surgery like a knee replacement you wouldn’t think it was so many,” he said, adding that the electronic prescribing system set the default at 90. So when he types in a prescription for Percocet, that’s the quantity the system orders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Such standard orders can be overridden, but that’s an extra step for a busy physician and takes time.\u003c/p>\n\u003cp>As public health officials grapple with how to slow the growing opioid epidemic — which \u003ca href=\"https://www.cdc.gov/drugoverdose/epidemic/\" target=\"_blank\" rel=\"noopener\">claims 91 lives each day\u003c/a>, according to federal statistics — the over-prescription of narcotics after even minor surgery is coming under new scrutiny.\u003c/p>\n\u003cp>While patients are today often given opioids to manage post-operative pain, a large supply of pills may open the door to opioid misuse, either by the patients themselves or others in the family or community who get access to the leftovers.\u003c/p>\n\u003cp>Post-surgical prescriptions for 45, 60 or 90 pills are “incredibly common,” said Dr. Chad Brummett, an anesthesiologist and pain physician at the University of Michigan Medical School.\u003c/p>\n\u003cp>Last year, the Centers for Disease Control and Prevention released a \u003ca href=\"https://www.cdc.gov/drugoverdose/pdf/Guidelines_Factsheet-a.pdf\" target=\"_blank\" rel=\"noopener\">general guideline\u003c/a> saying that clinicians who prescribe opioids to treat acute pain should use the lowest effective dose and limit the duration to no longer than seven days.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>But more detailed guidance is necessary, clinicians say.\u003c/p>\n\u003cp>“There really aren’t clear guidelines, especially for surgery and dentistry,” Dr. Brummett said. “It’s often based on what their chief resident taught them along the way, or an event in their career that made them prescribe a certain amount.” Or, as in my case, an automated program that makes prescribing more pills simpler than prescribing fewer.\u003c/p>\n\u003cp>To determine the extent to which surgery may lead to longer-term opioid use, Brummett and his colleagues examined the insurance claims of 36,177 adults who had surgery in 2013 or 2014 for which they received an opioid prescription. None of the patients had prescriptions for opioids during the prior year.\u003c/p>\n\u003cp>The study, published online in \u003ca href=\"https://jamanetwork.com/journals/jamasurgery/article-abstract/2618383\" target=\"_blank\" rel=\"noopener\">JAMA Surgery\u003c/a> in June, found that three to six months after surgery, roughly 6 percent of patients were still using opioids, having filled at least one new prescription for the drug. The figures were similar whether they had major or minor surgery. By comparison, the rate of opioid use for a control group that did not have surgery was just 0.4 percent.\u003c/p>\n\u003cp>Some insurers and state regulators have increasingly stepped in to limit opioid prescriptions. Insurers routinely monitor doctors’ prescribing patterns and limit the quantity of pills or the dosage of opioid prescriptions, said Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms who \u003ca href=\"http://chirblog.org/responding-opioid-crisis-insurers-balance-stepped-monitoring-restrictions-need-appropriate-pain-treatment/\" target=\"_blank\" rel=\"noopener\">co-authored a study\u003c/a> on insurers’ response to the opioid crisis.\u003c/p>\n\u003cp>At least two dozen states have passed laws or rules in just the past few years aimed at \u003ca href=\"http://www.painmed.org/advocacy/state-updates/\" target=\"_blank\" rel=\"noopener\">regulating the use of opioids\u003c/a>.\u003c/p>\n\u003cp>In my state of New York, Gov. Andrew Cuomo \u003ca href=\"https://www.governor.ny.gov/news/governor-cuomo-signs-legislation-combat-heroin-and-opioid-crisis\" target=\"_blank\" rel=\"noopener\">last year signed\u003c/a> legislation that \u003ca href=\"https://www.health.ny.gov/professionals/narcotic/laws_and_regulations/docs/combat_heroin_legislation_faq.pdf\" target=\"_blank\" rel=\"noopener\">reduced the initial opioid prescription\u003c/a> limit for acute pain from 30 days to no more than a seven-day supply.\u003c/p>\n\u003cp>As my experience demonstrated, however, a seven-day limit (those 42 pills in my case) can still result in patients receiving many more pills than they need. (For those who find themselves in a similar situation with excess pills, \u003ca href=\"https://khn.org/news/how-and-where-to-dump-your-leftover-drugs-responsibly/\" target=\"_blank\" rel=\"noopener\">here is the safe and proper way\u003c/a> to dispose of them.)\u003c/p>\n\u003cp>Still, some caregivers and patients worry that all this focus on overprescribing may scare physicians away from prescribing opioids at all, even when they’re appropriate.\u003c/p>\n\u003cp>“That’s my concern, that people are so afraid of things and taking it to such an extreme that patient care suffers,” said Dr. Edward Michna, an anesthesiologist and pain management physician at Brigham and Women’s Hospital in Boston who is on the board of the American Pain Society, a research and education group for pain management professionals. Michna has been a paid consultant to numerous pharmaceutical companies, some of which manufacture narcotics.\u003c/p>\n\u003cp>But other doctors say that one of the reasons doctors call in orders for lots of pills is their convenience.\u003c/p>\n\u003cp>“When you land on the front lines, you hear, ‘I like to write for 30 or 60 pills because that way they won’t call in the middle of the night’ ” for a refill, said Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins School of Medicine.\u003c/p>\n\u003cp>Makary is spearheading a consortium of Hopkins clinicians and patients that provides \u003ca href=\"https://www.solvethecrisis.org/best-practices\" target=\"_blank\" rel=\"noopener\">specific guidelines\u003c/a> for post-surgical opioid use. The program, part of a larger effort to identify areas of overtreatment in health care, also identifies outlier prescribers nationwide to encourage them to change their prescribing habits.\u003c/p>\n\u003cp>The Hopkins group doesn’t have an opioid recommendation for my surgery. The closest procedure on their website is arthroscopic surgery to partially remove a torn piece of cartilage in the knee called the meniscus. The post-surgical opioid recommendation following that surgery: 12 tablets.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>Please visit \u003ca href=\"https://khn.org/columnists/\" target=\"_blank\" rel=\"noopener\">khn.org/columnists\u003c/a> to send comments or ideas for future topics for the Insuring Your Health column.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/437388/doctors-rx-for-a-stiff-knee-a-prescription-for-90-percocet-pills","authors":["byline_futureofyou_437388"],"categories":["futureofyou_452"],"tags":["futureofyou_987","futureofyou_938","futureofyou_379","futureofyou_381"],"featImg":"futureofyou_437389","label":"futureofyou"},"futureofyou_436086":{"type":"posts","id":"futureofyou_436086","meta":{"index":"posts_1591205157","site":"futureofyou","id":"436086","score":null,"sort":[1509406004000]},"guestAuthors":[],"slug":"pain-patients-ditch-opioids-using-virtual-reality-video","title":"Using Virtual Reality, Not Opioids, to Reduce Pain (Video)","publishDate":1509406004,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>As part of its series on the opioid crisis, PBS NewsHour's Miles O'Brien earlier this month looked at cutting-edge pain treatment that allows patients to take fewer pills. These non-pharmacological approaches include hypnosis, physical therapy and even virtual reality.\u003c/p>\n\u003cp>The VR program is known as SnowWorld, and it's used to treat burn patients. O'Brien himself suffers from chronic pain related to a phantom limb -- he \u003ca href=\"https://www.usatoday.com/story/life/people/2014/02/25/miles-o-brien-amputation/5817755/\" target=\"_blank\" rel=\"noopener\">lost part of his left arm\u003c/a> in 2014 after an accident involving TV gear. In the video below, you'll see O'Brien use SnowWorld to withstand painful heat applied to his forearm.\u003c/p>\n\u003cp>\"Intent on hurling snowballs at penguins. I didn't feel heat at all,\" O'Brien says.\u003c/p>\n\u003cp>And he didn't feel the phantom pain from his missing limb, either.\u003c/p>\n\u003cp>Watch:\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>https://www.youtube.com/watch?v=DM9WrnvS8lM&ab_channel=PBSNewsHour\u003c/p>\n\n","blocks":[],"excerpt":"As part of its series on the opioid crisis, PBS NewsHour's Miles O'Brien earlier this month examined cutting-edge pain treatment that allows patients to take fewer pills.","status":"publish","parent":0,"modified":1509406881,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":7,"wordCount":146},"headData":{"title":"Using Virtual Reality, Not Opioids, to Reduce Pain (Video) | KQED","description":"As part of its series on the opioid crisis, PBS NewsHour's Miles O'Brien earlier this month examined cutting-edge pain treatment that allows patients to take fewer pills.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Using Virtual Reality, Not Opioids, to Reduce Pain (Video)","datePublished":"2017-10-30T23:26:44.000Z","dateModified":"2017-10-30T23:41:21.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"436086 https://ww2.kqed.org/futureofyou/?p=436086","disqusUrl":"https://ww2.kqed.org/futureofyou/2017/10/30/pain-patients-ditch-opioids-using-virtual-reality-video/","disqusTitle":"Using Virtual Reality, Not Opioids, to Reduce Pain (Video)","source":"Future of You","nprByline":"PBS NewsHour","path":"/futureofyou/436086/pain-patients-ditch-opioids-using-virtual-reality-video","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>As part of its series on the opioid crisis, PBS NewsHour's Miles O'Brien earlier this month looked at cutting-edge pain treatment that allows patients to take fewer pills. These non-pharmacological approaches include hypnosis, physical therapy and even virtual reality.\u003c/p>\n\u003cp>The VR program is known as SnowWorld, and it's used to treat burn patients. O'Brien himself suffers from chronic pain related to a phantom limb -- he \u003ca href=\"https://www.usatoday.com/story/life/people/2014/02/25/miles-o-brien-amputation/5817755/\" target=\"_blank\" rel=\"noopener\">lost part of his left arm\u003c/a> in 2014 after an accident involving TV gear. In the video below, you'll see O'Brien use SnowWorld to withstand painful heat applied to his forearm.\u003c/p>\n\u003cp>\"Intent on hurling snowballs at penguins. I didn't feel heat at all,\" O'Brien says.\u003c/p>\n\u003cp>And he didn't feel the phantom pain from his missing limb, either.\u003c/p>\n\u003cp>Watch:\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/DM9WrnvS8lM'\n title='//www.youtube.com/embed/DM9WrnvS8lM'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/436086/pain-patients-ditch-opioids-using-virtual-reality-video","authors":["byline_futureofyou_436086"],"categories":["futureofyou_452","futureofyou_1062","futureofyou_1","futureofyou_1063"],"tags":["futureofyou_938","futureofyou_379","futureofyou_380","futureofyou_668"],"featImg":"futureofyou_436721","label":"source_futureofyou_436086"},"futureofyou_175807":{"type":"posts","id":"futureofyou_175807","meta":{"index":"posts_1591205157","site":"futureofyou","id":"175807","score":null,"sort":[1465320552000]},"guestAuthors":[],"slug":"can-taking-tylenol-help-you-get-over-a-romantic-breakup-maybe","title":"Taking Tylenol for Heartache: The Relationship Between Physical and Emotional Pain","publishDate":1465320552,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>\u003cem>Adapted excerpt from WE HAVE THE TECHNOLOGY: How Biohackers, Foodies, Physicians, and Scientists are Transforming Human Perception, Once Sense at a Time by Kara Platoni. Copyright (c) 2015. Available from Basic Books, an imprint of Perseus Books, a division of PBG Publishing, LLC, a subsidiary of Hachette Book Group, Inc.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">N\u003c/span>aomi Eisenberger's office overlooks the sprawling UCLA campus. She’s been here her entire career, starting as a graduate student in health psychology. She was intrigued right off the bat by the connection between the social and the physical— “How is it that what goes on in our heads seems to influence what goes on in our bodies? Why does stress make us sick?”— and drawn to the neuroscientific techniques that have made these connections increasingly possible to examine.\u003c/p>\n\u003cp>She got hooked on studying social pain from the very beginning. “I think I have just always been curious about rejection,” she says in a soft, soothing voice. “Why does it seem to affect people so much? A lot of people have memories of early childhood experiences of being picked last for teams or left out by their friends on the playground.” In her own life as a grad student, she’d noticed this fear of rejection showing up as nervousness about public speaking.\u003c/p>\n\u003caside class=\"pullquote alignright\">If we turn up physical pain, does that turn up social pain? If we turn down social pain, does that turn down physical pain?\u003c/aside>\n\u003cp>One time, when she had a quiet moment by herself before a speech, she became suddenly aware of how rapidly her heart was beating. “It really feels like I’m being held up at gunpoint,” she thought to herself, “and this is weird, because all I’m doing is giving a talk.”\u003c/p>\n\u003cp>Eisenberger began studying the brain activity of people who had been socially rejected as part of a lab experiment. One day as she was looking at her data, she happened to be sitting next to a friend who was analyzing data from a pain study of patients with irritable bowel syndrome. “We just sort of noticed, ‘Isn’t that weird? The activations that you are seeing in your irritable bowel syndrome patients who are being exposed to painful stimulation look really similar to what we are seeing in this rejection study,’ ” she recalls. “These two things, maybe they are more similar than we thought. Maybe it’s not just a metaphor.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>What is Pain?\u003c/strong>\u003c/p>\n\u003cp>Now if you want to get to the bottom of whether social rejection actually hurts, the first dumb question you have to ask is, well, what is pain? And it turns out that the answer is not so obvious. When I ask Eisenberger, there’s a long pause. “That’s a super hard question!” she finally says with a light laugh.\u003c/p>\n\u003cp>“And I think depending on who you are talking to, different people care about different aspects of pain.”\u003c/p>\n\u003cp>For the record, she points out, there is an official definition, issued in 1979 by the International Association for the Study of Pain, a group of scientists, doctors, and others who research and advocate for pain relief. Their definition is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” That’s incredibly broad; it really tells you a lot more about how pain feels (bad) than how it works. But it’s telling that it encompasses the very linguistic mystery that Eisenberger and her colleagues set out to unpack. What is a broken heart if not an emotional experience described in terms of tissue damage?\u003c/p>\n\u003cp>There are reasons why describing pain is so hard. For one thing, it’s difficult to objectively measure something that is inherently subjective, points out Dr. Sean Mackey, chief of the Division of Pain Medicine at Stanford University, whose lab has also researched the idea of overlap between social and physical pain. How do you turn the sensation of pain into something you can count? “There is not a direct one-to-one correspondence between a specific quantum of stimulus and experience of pain,” Mackey says. How much pain a person experiences from a given stimulus can vary greatly— what is awful for one person might be tolerable, or even barely noticeable, for the next. Without an objective way to measure how much pain a person is in, medical and mental health practitioners must rely on the same feedback mechanism: the patient's self-report.\u003c/p>\n\u003caside class=\"pullquote alignright\">After three weeks, subjects taking acetaminophen reported fewer hurt feelings than those on a placebo.\u003c/aside>\n\u003cp>Pain is also polysensory; we feel it through many channels. People often think of touch first when it comes to pain, and some researchers indeed classify pain as a subset of somatosensation, the larger category that includes touch and temperature. We have nociceptors, or pain sensors, throughout our skin and soft tissue that are sensitive to environmental changes that might cause us bodily damage— pressure, temperature, chemical acidity. These nociceptors let us know when we’ve pinched our fingers in a drawer or burned our tongues on hot pizza or gotten shampoo in our eyes. It’s important to note that when we experience pain this way, it’s not because we’ve overstimulated the regular touch mechanoreceptors. We’ve actually activated an entirely separate system of receptors that don’t kick on until the force, temperature, or chemical irritant we are experiencing reaches a certain dangerous level. These impulses are relayed to the brain through a pathway separate from touch.\u003c/p>\n\u003cp class=\"p1\">But, Mackey argues, you can experience pain through any of your senses, not just touch. Ordinary light doesn’t hurt the eyes, but if the light’s too bright, he asks, “ doesn’t the light stimulus then become painful? And the same with sound. If you happen to have your ear next to a gunshot, isn’t that painful? You are exceeding a certain threshold for the sound pressure waves to be perceived as painful. What we believe is that these other sensory inputs can actually engage the same type of pain systems as if you hit your thumb with a hammer.”\u003c/p>\n\u003cp class=\"p1\">That’s an important idea: Pain has multiple sensory pathways that all feedback to the brain. Technically, Mackey says, what happens in the body (what a neuroscientist would refer to as the periphery, made up of the nerves and the spinal cord) is not exactly pain. It’s nociception, or the translation of real-world data into electrochemical signals signaling pain. Those signals get piped to the brain, where perception truly happens. “Pain is fundamentally a brain-related phenomenon,” Mackey says. The brain is where it all registers, “where the perception of pain is processed and perceived and modulated.”\u003c/p>\n\u003cfigure id=\"attachment_178526\" class=\"wp-caption alignright\" style=\"max-width: 321px\">\u003cimg class=\"wp-image-178526 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/havetech.jpg\" alt=\"Excerpt from 'We Have the Technology,' by Kara Platoni.\" width=\"321\" height=\"499\">\u003cfigcaption class=\"wp-caption-text\">Book excerpt from 'We Have the Technology,' by Kara Platoni.\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Another complication is that pain has several components, although not all researchers tally them up the same way. Eisenberger likes to speak of pain as having two main parts. The first is its sensory component, which is mainly objective information: Where is the pain coming from on the body, how intense is it, what is its nature? For example, she says, “is it a burning pain or an aching pain?” The second is its affective or emotional valence, how distressing or bothersome it is, and your urge to reduce its unpleasantness. Mackey thinks there are at least three components, possibly four. The third he calls the “cognitive evaluative” component, or your thought processes about how to get away from the pain and what the pain means. The fourth, which he says is less accepted and perhaps related to the third, is the idea of behavioral avoidance, or doing things to prevent future pain. In fact, that behavioral and motivational aspect of pain is probably the key missing component of the definition of pain, Mackey says. (Some experts combine these last three categories under a broader \"affective- motivational” heading.)\u003c/p>\n\u003cp>Different brain areas seem to be in charge of handling these dimensions of pain. As you might expect, the somatosensory cortex, which is involved with sensing touch, is involved with sensory pain. The anterior cingulate cortex and insular cortex— involved in processing emotion— are involved with pain’s affective dimension. The prefrontal area, which is involved in planning and decision making, is linked with its cognitive aspects. But, says Mackey, there’s really no clean break between these areas, which function as part of a larger system. “All of these regions are intimately connected to each other and each one is modulating the others,” he says. Many researchers refer to this as the “pain matrix,” says Eisenberger, a distributed network of regions that activate when you feel pain. “Some are involved more in sensory components, and some are more involved in the affective experience,” she says.\u003c/p>\n\u003cp>\u003cstrong>Tylenol and Lost Love\u003c/strong>\u003c/p>\n\u003cp class=\"p1\">And it’s here, within this idea of overlap and blur, that we get to Tylenol and lost love and \u003ca href=\"http://fmri.ucsd.edu/Research/whatisfmri.html\" target=\"_blank\">fMRI scanners\u003c/a>. If these areas are truly cross-chatting, painkillers that work to calm muscle tension should work to quell heartache, and vice versa -- love should be a balm. Or in experimental terms, says Eisenberger, “if we turn up physical pain, does that turn up social pain? If we turn down social pain, does that turn down physical pain?”\u003c/p>\n\u003cp class=\"p1\">This idea has its roots in the 1970s, when neuroscientist Jaak Panksepp realized that giving infant monkeys morphine— a potent painkiller— made them produce fewer distress cries when separated from their mothers. It was an important clue that an analgesic for physical pain reduced social pain. Other research avenues have explored how psychological factors can influence physical pain perception, like how the context of pain changes how strongly you feel it. Then there’s the placebo effect: Why do people taking inactive pills report that they feel better? But Eisenberger’s group was the first to test Panksepp’s idea in humans by putting people into a scanner and, well, rejecting them.\u003c/p>\n\u003cp class=\"p1\">It’s actually hard to reject someone who is lying inside a giant magnet. You can’t get anyone else in there. They’re not allowed to talk or move. It’s so noisy that they can’t really hear. But they can play Cyberball. Cyberball is the brainchild of Kipling Williams, a psychology professor at Purdue University, who came up with the idea after being slowly excluded from a real-life game of Frisbee that he’d run across in a park. In Cyberball, study subjects are asked to pass a virtual ball back and forth with several other players. At first, the other players pass the ball back. Then they start ignoring the subject, making it a game of virtual keep-away. The other “players” are actually a computer, programmed to eventually exclude the person. But the subject doesn’t know that, and feels stung by the snub.\u003c/p>\n\u003cp class=\"p1\">In their first 2003 study, Eisenberger and Williams’ group found that rejecting Cyberball players caused greater activity in the dorsal anterior cingular cortex (dACC) and anterior insula (AI), both regions otherwise associated with physical pain. And over the next several years, Eisenberger’s lab explored variations on this theme. They found that people who score high on tests for sensitivity to rejection have a heightened dACC response when shown images of disapproving faces. People asked to participate in an interview and then get feedback from an “evaluator” (really, a lab researcher) while lying in the scanner showed a bounce in dACC and AI activity after hearing themselves described with words like “boring” that connote rejection, but not after hearing neutral or accepting words. Teenagers who spend more time with friends show less activity in these pain areas when rejected during Cyberball.\u003c/p>\n\u003cp class=\"p1\">Other labs were exploring, too. One particularly interesting 2011 study, led by social psychologist Ethan Kross at the University of Michigan, asked people who had just been through unwanted breakups to look at pictures of their exes, arguing that this painful stimulus would be even more acute than being left out of an imaginary game or criticized by strangers. Subjects lying in the scanner either looked at a picture of their former partner and thought about being rejected by them or viewed a photo of a friend and recalled a recent positive experience with them. To establish a baseline of which brain areas react to physical pain, a separate group of subjects was scanned while feeling either painfully hot or neutrally warm stimulation on their forearms. (Pain in these experiments is typically administered to the arm using a small\u003cbr>\nwand with an electric thermode at the end that delivers a sharp heat; it feels, Eisenberger says, more like a sting than a burn.) The researchers found that not only did people report more pain when looking at their exes, but their brains showed more activity in the dACC and AI areas— the same ones that became more active for the people touching the hot object.\u003c/p>\n\u003cp class=\"p1\">With the evidence mounting that social pain inflames the brain’s physical pain centers, it was time to try the reverse: to see if you could use physical pain remedies to calm social pain down. In 2010, social psychologist Dr. C. Nathan DeWall at the University of Kentucky, collaborating with Eisenberger and others, tested the social pain-killing power of Tylenol, or rather, the generic acetaminophen. DeWall first asked his subjects to take either acetaminophen or placebo pills daily. Every night, they logged how much social pain they had experienced that day using a “Hurt Feelings Scale” developed to gauge the pain of rejection, but not other negative emotions. They also recorded their day using a separate scale that measured positive feelings. After three weeks, the subjects taking the acetaminophen reported fewer hurt feelings than those on the placebo, but not an increase in good ones, suggesting that the drug was tamping down bad feelings, not enhancing the positive ones.\u003c/p>\n\u003cp class=\"p1\">In the next stage of the study, DeWall’s subjects once again took either acetaminophen or a placebo for three weeks, and then got in the scanner to play Cyberball and be roundly rejected. The participants who took the acetaminophen showed less activation in both the dACC and the bilateral anterior insula. (Interestingly, while their brain activity differed, being left out of Cyberball felt equally distressing to both groups.) These results, DeWall says, suggest that “we put all of these different painful or unpleasant events in separate buckets in our heads, but there is a common mechanism underlying them.”\u003c/p>\n\u003cp class=\"p1\">So should doctors start prescribing Tylenol for people going through breakups? “I don’t know,” DeWall muses. While the authors didn’t go so far as to recommend that people start routinely popping Tylenol to inure themselves to negative feelings, they did write that it might offer temporary relief from social pain, and suggested further research to see if it can also dampen the aggression and antisocial behavior that can follow rejection. Since the study came out, DeWall says, he’s gotten a lot of letters from people sharing anecdotes about their own attempts to self- medicate for a broken heart, but so far there’s been no clinical trial testing Tylenol on the lovelorn.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p1\">There’s an X factor, too, in that it’s not very well understood how acetaminophen kills pain in the first place. “Does it work on central pain versus peripheral pain?” asks DeWall. “Honestly, we don’t know enough to make a definitive statement about it.” But he does know that it activates cannabinoid1 brain receptors, which are also activated by THC, the psychoactive component of marijuana. In 2013, along with several collaborators, he published the results of four studies investigating the effect of pot on social pain. The first three were correlational analyses, in which they argued that marijuana use correlates with lower self-reports of loneliness and incidents of serious depression, both indicators of social alienation. The fourth asked people to play Cyberball, but only half of them got a version in which other players excluded them. Afterward, the players filled out a scale that assessed how threatened they felt their emotional needs— self-esteem, belonging, control— were during the game. Frequent marijuana smokers reported feeling less threatened than the infrequent ones. Again, the authors didn’t suggest everyone light up to avoid social pain—in fact, they wrote, people might smoke pot because they feel socially rejected. But they did suggest that both drugs suppress social pain by acting on the same cannabinoid 1 receptors, and pointed out that once again a drug that is—at least in some states— legally used for physical pain seems to also alleviate social distress.\u003c/p>\n\n","blocks":[],"excerpt":"The pain from hitting your thumb with a hammer and the pain from getting dumped engage the same areas of the brain. Meaning painkillers that work to calm muscle tension could work to quell heartache, and vice versa.","status":"publish","parent":0,"modified":1514569141,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":15,"wordCount":3073},"headData":{"title":"Taking Tylenol for Heartache: The Relationship Between Physical and Emotional Pain | KQED","description":"The pain from hitting your thumb with a hammer and the pain from getting dumped engage the same areas of the brain. Meaning painkillers that work to calm muscle tension could work to quell heartache, and vice versa.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Taking Tylenol for Heartache: The Relationship Between Physical and Emotional Pain","datePublished":"2016-06-07T17:29:12.000Z","dateModified":"2017-12-29T17:39:01.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"175807 http://ww2.kqed.org/futureofyou/?p=175807","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/06/07/can-taking-tylenol-help-you-get-over-a-romantic-breakup-maybe/","disqusTitle":"Taking Tylenol for Heartache: The Relationship Between Physical and Emotional Pain","nprByline":"Kara Platoni","path":"/futureofyou/175807/can-taking-tylenol-help-you-get-over-a-romantic-breakup-maybe","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Adapted excerpt from WE HAVE THE TECHNOLOGY: How Biohackers, Foodies, Physicians, and Scientists are Transforming Human Perception, Once Sense at a Time by Kara Platoni. Copyright (c) 2015. Available from Basic Books, an imprint of Perseus Books, a division of PBG Publishing, LLC, a subsidiary of Hachette Book Group, Inc.\u003c/em>\u003c/p>\n\u003cp>\u003cspan style=\"font-size: 4.6875em;float: left;line-height: 0.733em;padding: 0.05em 0.1em 0 0;font-family: times, serif, georgia\">N\u003c/span>aomi Eisenberger's office overlooks the sprawling UCLA campus. She’s been here her entire career, starting as a graduate student in health psychology. She was intrigued right off the bat by the connection between the social and the physical— “How is it that what goes on in our heads seems to influence what goes on in our bodies? Why does stress make us sick?”— and drawn to the neuroscientific techniques that have made these connections increasingly possible to examine.\u003c/p>\n\u003cp>She got hooked on studying social pain from the very beginning. “I think I have just always been curious about rejection,” she says in a soft, soothing voice. “Why does it seem to affect people so much? A lot of people have memories of early childhood experiences of being picked last for teams or left out by their friends on the playground.” In her own life as a grad student, she’d noticed this fear of rejection showing up as nervousness about public speaking.\u003c/p>\n\u003caside class=\"pullquote alignright\">If we turn up physical pain, does that turn up social pain? If we turn down social pain, does that turn down physical pain?\u003c/aside>\n\u003cp>One time, when she had a quiet moment by herself before a speech, she became suddenly aware of how rapidly her heart was beating. “It really feels like I’m being held up at gunpoint,” she thought to herself, “and this is weird, because all I’m doing is giving a talk.”\u003c/p>\n\u003cp>Eisenberger began studying the brain activity of people who had been socially rejected as part of a lab experiment. One day as she was looking at her data, she happened to be sitting next to a friend who was analyzing data from a pain study of patients with irritable bowel syndrome. “We just sort of noticed, ‘Isn’t that weird? The activations that you are seeing in your irritable bowel syndrome patients who are being exposed to painful stimulation look really similar to what we are seeing in this rejection study,’ ” she recalls. “These two things, maybe they are more similar than we thought. Maybe it’s not just a metaphor.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>What is Pain?\u003c/strong>\u003c/p>\n\u003cp>Now if you want to get to the bottom of whether social rejection actually hurts, the first dumb question you have to ask is, well, what is pain? And it turns out that the answer is not so obvious. When I ask Eisenberger, there’s a long pause. “That’s a super hard question!” she finally says with a light laugh.\u003c/p>\n\u003cp>“And I think depending on who you are talking to, different people care about different aspects of pain.”\u003c/p>\n\u003cp>For the record, she points out, there is an official definition, issued in 1979 by the International Association for the Study of Pain, a group of scientists, doctors, and others who research and advocate for pain relief. Their definition is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” That’s incredibly broad; it really tells you a lot more about how pain feels (bad) than how it works. But it’s telling that it encompasses the very linguistic mystery that Eisenberger and her colleagues set out to unpack. What is a broken heart if not an emotional experience described in terms of tissue damage?\u003c/p>\n\u003cp>There are reasons why describing pain is so hard. For one thing, it’s difficult to objectively measure something that is inherently subjective, points out Dr. Sean Mackey, chief of the Division of Pain Medicine at Stanford University, whose lab has also researched the idea of overlap between social and physical pain. How do you turn the sensation of pain into something you can count? “There is not a direct one-to-one correspondence between a specific quantum of stimulus and experience of pain,” Mackey says. How much pain a person experiences from a given stimulus can vary greatly— what is awful for one person might be tolerable, or even barely noticeable, for the next. Without an objective way to measure how much pain a person is in, medical and mental health practitioners must rely on the same feedback mechanism: the patient's self-report.\u003c/p>\n\u003caside class=\"pullquote alignright\">After three weeks, subjects taking acetaminophen reported fewer hurt feelings than those on a placebo.\u003c/aside>\n\u003cp>Pain is also polysensory; we feel it through many channels. People often think of touch first when it comes to pain, and some researchers indeed classify pain as a subset of somatosensation, the larger category that includes touch and temperature. We have nociceptors, or pain sensors, throughout our skin and soft tissue that are sensitive to environmental changes that might cause us bodily damage— pressure, temperature, chemical acidity. These nociceptors let us know when we’ve pinched our fingers in a drawer or burned our tongues on hot pizza or gotten shampoo in our eyes. It’s important to note that when we experience pain this way, it’s not because we’ve overstimulated the regular touch mechanoreceptors. We’ve actually activated an entirely separate system of receptors that don’t kick on until the force, temperature, or chemical irritant we are experiencing reaches a certain dangerous level. These impulses are relayed to the brain through a pathway separate from touch.\u003c/p>\n\u003cp class=\"p1\">But, Mackey argues, you can experience pain through any of your senses, not just touch. Ordinary light doesn’t hurt the eyes, but if the light’s too bright, he asks, “ doesn’t the light stimulus then become painful? And the same with sound. If you happen to have your ear next to a gunshot, isn’t that painful? You are exceeding a certain threshold for the sound pressure waves to be perceived as painful. What we believe is that these other sensory inputs can actually engage the same type of pain systems as if you hit your thumb with a hammer.”\u003c/p>\n\u003cp class=\"p1\">That’s an important idea: Pain has multiple sensory pathways that all feedback to the brain. Technically, Mackey says, what happens in the body (what a neuroscientist would refer to as the periphery, made up of the nerves and the spinal cord) is not exactly pain. It’s nociception, or the translation of real-world data into electrochemical signals signaling pain. Those signals get piped to the brain, where perception truly happens. “Pain is fundamentally a brain-related phenomenon,” Mackey says. The brain is where it all registers, “where the perception of pain is processed and perceived and modulated.”\u003c/p>\n\u003cfigure id=\"attachment_178526\" class=\"wp-caption alignright\" style=\"max-width: 321px\">\u003cimg class=\"wp-image-178526 size-full\" src=\"http://ww2.kqed.org/futureofyou/wp-content/uploads/sites/13/2017/06/havetech.jpg\" alt=\"Excerpt from 'We Have the Technology,' by Kara Platoni.\" width=\"321\" height=\"499\">\u003cfigcaption class=\"wp-caption-text\">Book excerpt from 'We Have the Technology,' by Kara Platoni.\u003c/figcaption>\u003c/figure>\n\u003cp class=\"p1\">Another complication is that pain has several components, although not all researchers tally them up the same way. Eisenberger likes to speak of pain as having two main parts. The first is its sensory component, which is mainly objective information: Where is the pain coming from on the body, how intense is it, what is its nature? For example, she says, “is it a burning pain or an aching pain?” The second is its affective or emotional valence, how distressing or bothersome it is, and your urge to reduce its unpleasantness. Mackey thinks there are at least three components, possibly four. The third he calls the “cognitive evaluative” component, or your thought processes about how to get away from the pain and what the pain means. The fourth, which he says is less accepted and perhaps related to the third, is the idea of behavioral avoidance, or doing things to prevent future pain. In fact, that behavioral and motivational aspect of pain is probably the key missing component of the definition of pain, Mackey says. (Some experts combine these last three categories under a broader \"affective- motivational” heading.)\u003c/p>\n\u003cp>Different brain areas seem to be in charge of handling these dimensions of pain. As you might expect, the somatosensory cortex, which is involved with sensing touch, is involved with sensory pain. The anterior cingulate cortex and insular cortex— involved in processing emotion— are involved with pain’s affective dimension. The prefrontal area, which is involved in planning and decision making, is linked with its cognitive aspects. But, says Mackey, there’s really no clean break between these areas, which function as part of a larger system. “All of these regions are intimately connected to each other and each one is modulating the others,” he says. Many researchers refer to this as the “pain matrix,” says Eisenberger, a distributed network of regions that activate when you feel pain. “Some are involved more in sensory components, and some are more involved in the affective experience,” she says.\u003c/p>\n\u003cp>\u003cstrong>Tylenol and Lost Love\u003c/strong>\u003c/p>\n\u003cp class=\"p1\">And it’s here, within this idea of overlap and blur, that we get to Tylenol and lost love and \u003ca href=\"http://fmri.ucsd.edu/Research/whatisfmri.html\" target=\"_blank\">fMRI scanners\u003c/a>. If these areas are truly cross-chatting, painkillers that work to calm muscle tension should work to quell heartache, and vice versa -- love should be a balm. Or in experimental terms, says Eisenberger, “if we turn up physical pain, does that turn up social pain? If we turn down social pain, does that turn down physical pain?”\u003c/p>\n\u003cp class=\"p1\">This idea has its roots in the 1970s, when neuroscientist Jaak Panksepp realized that giving infant monkeys morphine— a potent painkiller— made them produce fewer distress cries when separated from their mothers. It was an important clue that an analgesic for physical pain reduced social pain. Other research avenues have explored how psychological factors can influence physical pain perception, like how the context of pain changes how strongly you feel it. Then there’s the placebo effect: Why do people taking inactive pills report that they feel better? But Eisenberger’s group was the first to test Panksepp’s idea in humans by putting people into a scanner and, well, rejecting them.\u003c/p>\n\u003cp class=\"p1\">It’s actually hard to reject someone who is lying inside a giant magnet. You can’t get anyone else in there. They’re not allowed to talk or move. It’s so noisy that they can’t really hear. But they can play Cyberball. Cyberball is the brainchild of Kipling Williams, a psychology professor at Purdue University, who came up with the idea after being slowly excluded from a real-life game of Frisbee that he’d run across in a park. In Cyberball, study subjects are asked to pass a virtual ball back and forth with several other players. At first, the other players pass the ball back. Then they start ignoring the subject, making it a game of virtual keep-away. The other “players” are actually a computer, programmed to eventually exclude the person. But the subject doesn’t know that, and feels stung by the snub.\u003c/p>\n\u003cp class=\"p1\">In their first 2003 study, Eisenberger and Williams’ group found that rejecting Cyberball players caused greater activity in the dorsal anterior cingular cortex (dACC) and anterior insula (AI), both regions otherwise associated with physical pain. And over the next several years, Eisenberger’s lab explored variations on this theme. They found that people who score high on tests for sensitivity to rejection have a heightened dACC response when shown images of disapproving faces. People asked to participate in an interview and then get feedback from an “evaluator” (really, a lab researcher) while lying in the scanner showed a bounce in dACC and AI activity after hearing themselves described with words like “boring” that connote rejection, but not after hearing neutral or accepting words. Teenagers who spend more time with friends show less activity in these pain areas when rejected during Cyberball.\u003c/p>\n\u003cp class=\"p1\">Other labs were exploring, too. One particularly interesting 2011 study, led by social psychologist Ethan Kross at the University of Michigan, asked people who had just been through unwanted breakups to look at pictures of their exes, arguing that this painful stimulus would be even more acute than being left out of an imaginary game or criticized by strangers. Subjects lying in the scanner either looked at a picture of their former partner and thought about being rejected by them or viewed a photo of a friend and recalled a recent positive experience with them. To establish a baseline of which brain areas react to physical pain, a separate group of subjects was scanned while feeling either painfully hot or neutrally warm stimulation on their forearms. (Pain in these experiments is typically administered to the arm using a small\u003cbr>\nwand with an electric thermode at the end that delivers a sharp heat; it feels, Eisenberger says, more like a sting than a burn.) The researchers found that not only did people report more pain when looking at their exes, but their brains showed more activity in the dACC and AI areas— the same ones that became more active for the people touching the hot object.\u003c/p>\n\u003cp class=\"p1\">With the evidence mounting that social pain inflames the brain’s physical pain centers, it was time to try the reverse: to see if you could use physical pain remedies to calm social pain down. In 2010, social psychologist Dr. C. Nathan DeWall at the University of Kentucky, collaborating with Eisenberger and others, tested the social pain-killing power of Tylenol, or rather, the generic acetaminophen. DeWall first asked his subjects to take either acetaminophen or placebo pills daily. Every night, they logged how much social pain they had experienced that day using a “Hurt Feelings Scale” developed to gauge the pain of rejection, but not other negative emotions. They also recorded their day using a separate scale that measured positive feelings. After three weeks, the subjects taking the acetaminophen reported fewer hurt feelings than those on the placebo, but not an increase in good ones, suggesting that the drug was tamping down bad feelings, not enhancing the positive ones.\u003c/p>\n\u003cp class=\"p1\">In the next stage of the study, DeWall’s subjects once again took either acetaminophen or a placebo for three weeks, and then got in the scanner to play Cyberball and be roundly rejected. The participants who took the acetaminophen showed less activation in both the dACC and the bilateral anterior insula. (Interestingly, while their brain activity differed, being left out of Cyberball felt equally distressing to both groups.) These results, DeWall says, suggest that “we put all of these different painful or unpleasant events in separate buckets in our heads, but there is a common mechanism underlying them.”\u003c/p>\n\u003cp class=\"p1\">So should doctors start prescribing Tylenol for people going through breakups? “I don’t know,” DeWall muses. While the authors didn’t go so far as to recommend that people start routinely popping Tylenol to inure themselves to negative feelings, they did write that it might offer temporary relief from social pain, and suggested further research to see if it can also dampen the aggression and antisocial behavior that can follow rejection. Since the study came out, DeWall says, he’s gotten a lot of letters from people sharing anecdotes about their own attempts to self- medicate for a broken heart, but so far there’s been no clinical trial testing Tylenol on the lovelorn.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">There’s an X factor, too, in that it’s not very well understood how acetaminophen kills pain in the first place. “Does it work on central pain versus peripheral pain?” asks DeWall. “Honestly, we don’t know enough to make a definitive statement about it.” But he does know that it activates cannabinoid1 brain receptors, which are also activated by THC, the psychoactive component of marijuana. In 2013, along with several collaborators, he published the results of four studies investigating the effect of pot on social pain. The first three were correlational analyses, in which they argued that marijuana use correlates with lower self-reports of loneliness and incidents of serious depression, both indicators of social alienation. The fourth asked people to play Cyberball, but only half of them got a version in which other players excluded them. Afterward, the players filled out a scale that assessed how threatened they felt their emotional needs— self-esteem, belonging, control— were during the game. Frequent marijuana smokers reported feeling less threatened than the infrequent ones. Again, the authors didn’t suggest everyone light up to avoid social pain—in fact, they wrote, people might smoke pot because they feel socially rejected. But they did suggest that both drugs suppress social pain by acting on the same cannabinoid 1 receptors, and pointed out that once again a drug that is—at least in some states— legally used for physical pain seems to also alleviate social distress.\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/175807/can-taking-tylenol-help-you-get-over-a-romantic-breakup-maybe","authors":["byline_futureofyou_175807"],"categories":["futureofyou_1062"],"tags":["futureofyou_1439","futureofyou_880","futureofyou_80","futureofyou_379","futureofyou_881"],"featImg":"futureofyou_179244","label":"futureofyou"},"futureofyou_140326":{"type":"posts","id":"futureofyou_140326","meta":{"index":"posts_1591205157","site":"futureofyou","id":"140326","score":null,"sort":[1459904971000]},"guestAuthors":[],"slug":"false-beliefs-about-race-may-lead-doctors-to-minimize-pain-in-blacks","title":"False Beliefs About Blacks' Biology May Lead Doctors to Underprescribe for Pain","publishDate":1459904971,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{"site":"futureofyou"},"content":"\u003cp>Despite what that uncle of yours may opine every time you get stuck next to him at Thanksgiving, there is a fair amount of evidence that racism still exists in the United States. For example, we know about racial disparities in \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2015/04/north_charleston_shooting_how_investigatory_traffic_stops_unfairly_affect.html\" target=\"_blank\">policing\u003c/a>, \u003ca href=\"http://www.npr.org/2013/05/04/181053769/fewer-jobs-persistent-racial-disparity\" target=\"_blank\">unemployment\u003c/a>, \u003ca href=\"http://www.businessinsider.com/great-recession-exacerbated-a-big-racial-disparity-in-the-housing-market-2015-6\" target=\"_blank\">housing wealth\u003c/a>, \u003ca href=\"https://www.revealnews.org/article/when-companies-hire-temp-workers-by-race-black-applicants-lose-out/\" target=\"_blank\">temp hiring\u003c/a>, \u003ca href=\"http://www.motherjones.com/mojo/2015/07/race-gender-interest-rates-mortgages\" target=\"_blank\">home loans\u003c/a>, \u003ca href=\"http://www.npr.org/sections/thesalt/2015/10/22/450863158/the-startling-racial-divide-in-pay-for-restaurant-workers\" target=\"_blank\">pay\u003c/a>, the \u003ca href=\"https://www.washingtonpost.com/news/arts-and-entertainment/wp/2016/02/28/academy-awards-presenters-black-oscar-winners-history/\" target=\"_blank\">Oscars\u003c/a> , and of course, \u003ca href=\"http://www.cbsnews.com/news/dr-damon-tweedy-race-medicine-new-book-black-man-in-a-white-coat/\" target=\"_blank\">health care\u003c/a>.\u003c/p>\n\u003cp>One way bias has manifested in the practice of medicine is in the treatment of pain. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10613935\" target=\"_blank\">study\u003c/a> published in 2000, for example, found white patients were significantly more likely than black patients to receive pain medication for bone fractures in an emergency room. Further research has borne out unequal pain treatment -- even in \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2441797\" target=\"_blank\">children\u003c/a>.\u003c/p>\n\u003cp>So why does this happen?\u003c/p>\n\u003cp>Researchers who have published a new \u003ca href=\"http://www.pnas.org/content/early/2016/03/30/1516047113.abstract\" target=\"_blank\">study\u003c/a> in the Proceedings of the National Academy of Sciences say they may have found the answer. And it's not pretty.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[A] substantial number of white people -- laypersons with no medical training, and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.'\u003ccite>University of Virginia study\u003c/cite>\u003c/aside>\n\u003cp>Some doctors may under-treat the pain of African-Americans because they believe there are biological differences between black and white people that result in blacks feeling less pain.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"Our findings show that beliefs about black-white differences in biology may contribute to this disparity,” Kelly Hoffman, a sixth-year doctoral candidate in the University of Virginia's social psychology program, said in a press release.\u003c/p>\n\u003cp>Researchers conducted two separate surveys among white, native English speakers: one group that had no medical training, and one group of medical students and residents. In both groups, they found that the more false beliefs participants held about biological differences between black and white people, the more they minimized the pain of black people.\u003c/p>\n\u003cp>The first study was conducted among 92 people with no medical training. These individuals were asked to rate the level of pain a randomly assigned black or white hypothetical patient would feel in various situations, such as getting a hand slammed in a car door.\u003c/p>\n\u003cp>The group then was asked to what extent 15 statements about biological differences between blacks and whites were true. Eleven of the statements, such as \"Black people’s skin has more collagen (i.e. it’s thicker) than White people’s skin,\" were false, and four, such as \"Whites are less susceptible to heart disease,\" were true.\u003c/p>\n\u003cp>[contextly_sidebar id=\"lRl5cKSmSexqMugwZnroQmTLXkb8QpAW\"]The researchers found that participants who believed more of these false statements rated the pain experienced by black patients lower than the pain experienced by white patients.\u003c/p>\n\u003cp>\"In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker,\" wrote the study's authors.\u003c/p>\n\u003cp>Now here's where it gets especially alarming. Having found that false beliefs about biological differences between blacks and whites correlates with racial bias in pain perception among laypeople, the researchers moved on to doctors in training.\u003c/p>\n\u003cp>They asked 222 medical students and residents -- again white, native English speakers -- to rate the degree of truth of the same beliefs about biological differences between black and white people.\u003c/p>\n\u003cp>The results: The doctors-in-training believed nearly 12 percent of the false statements, and half believed at least one.\u003c/p>\n\u003cp>\"These percentages are noticeably lower compared with those in study 1,\" the researchers wrote, \"however, given this sample (medical students and residents), the percentages for false beliefs are surprisingly high.\"\u003c/p>\n\u003cp>The medical students and residents were also asked to rate on a scale of zero to 10 the pain levels experienced in two mock medical cases, involving a kidney stone and a leg fracture, for both a white and a black patient.\u003c/p>\n\u003cp>And again, the participants who endorsed more false beliefs about biological differences also rated black patients as feeling less pain than white patients.\u003c/p>\n\u003cp>When asked to recommend pain medication for each scenario, the students and residents with more false beliefs underprescribed pain medication for the black patients, as determined by 10 experienced physicians. These participants recommended Tylenol, anti-inflammatory medication or an ice pack, as opposed to a narcotic like hydrocodone or morphine, which would be in line with World Health Organization guidelines, according to the researchers.\u003c/p>\n\u003cp>Interestingly enough, those medical students who either did not believe the false statements, or believed fewer of them, showed an opposite bias in terms of their perceptions of pain -- meaning they thought \u003cem>white\u003c/em> patients feel less pain. Importantly, however, this bias was not associated with insufficient treatment recommendations.\u003c/p>\n\u003cp>\"It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients,\" the authors wrote.\u003c/p>\n\u003cp>Beyond that, the authors specifically remarked on the markedly outdated nature of the false beliefs in question.\u003c/p>\n\u003cp>\"(A) substantial number of white people -- laypersons with no medical training and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.\" (And which go back to the era of slavery, the authors note.)\u003c/p>\n\u003cp>\"To our knowledge, this is the first demonstration of medical personnel (students and residents) with at least some medical training) endorsing such beliefs in modern times.\"\u003c/p>\n\u003cp>I have yet to get a hold of lead researcher Kelly Hoffman on the phone. \"I apologize for the delay,\" she wrote in an email. \"I have been inundated with requests.\"\u003c/p>\n\u003cp>One can imagine.\u003c/p>\n\u003cp>And how many of \u003ca href=\"http://ww2.kqed.org/futureofyou/which-of-these-statements-about-biological-differences-between-blacks-and-whites-are-true/\" target=\"_blank\">these statements\u003c/a> about biological differences between black and white people do \u003cem>you\u003c/em> think are true?\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"A new study finds that the more false beliefs medical students held about black people's biology, the more likely they were to underprescribe pain medication.","status":"publish","parent":0,"modified":1459957108,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":28,"wordCount":975},"headData":{"title":"False Beliefs About Blacks' Biology May Lead Doctors to Underprescribe for Pain | KQED","description":"A new study finds that the more false beliefs medical students held about black people's biology, the more likely they were to underprescribe pain medication.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"False Beliefs About Blacks' Biology May Lead Doctors to Underprescribe for Pain","datePublished":"2016-04-06T01:09:31.000Z","dateModified":"2016-04-06T15:38:28.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"140326 http://ww2.kqed.org/futureofyou/?p=140326","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/04/05/false-beliefs-about-race-may-lead-doctors-to-minimize-pain-in-blacks/","disqusTitle":"False Beliefs About Blacks' Biology May Lead Doctors to Underprescribe for Pain","path":"/futureofyou/140326/false-beliefs-about-race-may-lead-doctors-to-minimize-pain-in-blacks","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Despite what that uncle of yours may opine every time you get stuck next to him at Thanksgiving, there is a fair amount of evidence that racism still exists in the United States. For example, we know about racial disparities in \u003ca href=\"http://www.slate.com/articles/news_and_politics/politics/2015/04/north_charleston_shooting_how_investigatory_traffic_stops_unfairly_affect.html\" target=\"_blank\">policing\u003c/a>, \u003ca href=\"http://www.npr.org/2013/05/04/181053769/fewer-jobs-persistent-racial-disparity\" target=\"_blank\">unemployment\u003c/a>, \u003ca href=\"http://www.businessinsider.com/great-recession-exacerbated-a-big-racial-disparity-in-the-housing-market-2015-6\" target=\"_blank\">housing wealth\u003c/a>, \u003ca href=\"https://www.revealnews.org/article/when-companies-hire-temp-workers-by-race-black-applicants-lose-out/\" target=\"_blank\">temp hiring\u003c/a>, \u003ca href=\"http://www.motherjones.com/mojo/2015/07/race-gender-interest-rates-mortgages\" target=\"_blank\">home loans\u003c/a>, \u003ca href=\"http://www.npr.org/sections/thesalt/2015/10/22/450863158/the-startling-racial-divide-in-pay-for-restaurant-workers\" target=\"_blank\">pay\u003c/a>, the \u003ca href=\"https://www.washingtonpost.com/news/arts-and-entertainment/wp/2016/02/28/academy-awards-presenters-black-oscar-winners-history/\" target=\"_blank\">Oscars\u003c/a> , and of course, \u003ca href=\"http://www.cbsnews.com/news/dr-damon-tweedy-race-medicine-new-book-black-man-in-a-white-coat/\" target=\"_blank\">health care\u003c/a>.\u003c/p>\n\u003cp>One way bias has manifested in the practice of medicine is in the treatment of pain. A \u003ca href=\"http://www.ncbi.nlm.nih.gov/pubmed/10613935\" target=\"_blank\">study\u003c/a> published in 2000, for example, found white patients were significantly more likely than black patients to receive pain medication for bone fractures in an emergency room. Further research has borne out unequal pain treatment -- even in \u003ca href=\"http://archpedi.jamanetwork.com/article.aspx?articleid=2441797\" target=\"_blank\">children\u003c/a>.\u003c/p>\n\u003cp>So why does this happen?\u003c/p>\n\u003cp>Researchers who have published a new \u003ca href=\"http://www.pnas.org/content/early/2016/03/30/1516047113.abstract\" target=\"_blank\">study\u003c/a> in the Proceedings of the National Academy of Sciences say they may have found the answer. And it's not pretty.\u003c/p>\n\u003caside class=\"pullquote alignright\">'[A] substantial number of white people -- laypersons with no medical training, and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.'\u003ccite>University of Virginia study\u003c/cite>\u003c/aside>\n\u003cp>Some doctors may under-treat the pain of African-Americans because they believe there are biological differences between black and white people that result in blacks feeling less pain.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"Our findings show that beliefs about black-white differences in biology may contribute to this disparity,” Kelly Hoffman, a sixth-year doctoral candidate in the University of Virginia's social psychology program, said in a press release.\u003c/p>\n\u003cp>Researchers conducted two separate surveys among white, native English speakers: one group that had no medical training, and one group of medical students and residents. In both groups, they found that the more false beliefs participants held about biological differences between black and white people, the more they minimized the pain of black people.\u003c/p>\n\u003cp>The first study was conducted among 92 people with no medical training. These individuals were asked to rate the level of pain a randomly assigned black or white hypothetical patient would feel in various situations, such as getting a hand slammed in a car door.\u003c/p>\n\u003cp>The group then was asked to what extent 15 statements about biological differences between blacks and whites were true. Eleven of the statements, such as \"Black people’s skin has more collagen (i.e. it’s thicker) than White people’s skin,\" were false, and four, such as \"Whites are less susceptible to heart disease,\" were true.\u003c/p>\n\u003cp>\u003c/p>\u003cp>\u003c/p>\u003cp>The researchers found that participants who believed more of these false statements rated the pain experienced by black patients lower than the pain experienced by white patients.\u003c/p>\n\u003cp>\"In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker,\" wrote the study's authors.\u003c/p>\n\u003cp>Now here's where it gets especially alarming. Having found that false beliefs about biological differences between blacks and whites correlates with racial bias in pain perception among laypeople, the researchers moved on to doctors in training.\u003c/p>\n\u003cp>They asked 222 medical students and residents -- again white, native English speakers -- to rate the degree of truth of the same beliefs about biological differences between black and white people.\u003c/p>\n\u003cp>The results: The doctors-in-training believed nearly 12 percent of the false statements, and half believed at least one.\u003c/p>\n\u003cp>\"These percentages are noticeably lower compared with those in study 1,\" the researchers wrote, \"however, given this sample (medical students and residents), the percentages for false beliefs are surprisingly high.\"\u003c/p>\n\u003cp>The medical students and residents were also asked to rate on a scale of zero to 10 the pain levels experienced in two mock medical cases, involving a kidney stone and a leg fracture, for both a white and a black patient.\u003c/p>\n\u003cp>And again, the participants who endorsed more false beliefs about biological differences also rated black patients as feeling less pain than white patients.\u003c/p>\n\u003cp>When asked to recommend pain medication for each scenario, the students and residents with more false beliefs underprescribed pain medication for the black patients, as determined by 10 experienced physicians. These participants recommended Tylenol, anti-inflammatory medication or an ice pack, as opposed to a narcotic like hydrocodone or morphine, which would be in line with World Health Organization guidelines, according to the researchers.\u003c/p>\n\u003cp>Interestingly enough, those medical students who either did not believe the false statements, or believed fewer of them, showed an opposite bias in terms of their perceptions of pain -- meaning they thought \u003cem>white\u003c/em> patients feel less pain. Importantly, however, this bias was not associated with insufficient treatment recommendations.\u003c/p>\n\u003cp>\"It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients,\" the authors wrote.\u003c/p>\n\u003cp>Beyond that, the authors specifically remarked on the markedly outdated nature of the false beliefs in question.\u003c/p>\n\u003cp>\"(A) substantial number of white people -- laypersons with no medical training and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature.\" (And which go back to the era of slavery, the authors note.)\u003c/p>\n\u003cp>\"To our knowledge, this is the first demonstration of medical personnel (students and residents) with at least some medical training) endorsing such beliefs in modern times.\"\u003c/p>\n\u003cp>I have yet to get a hold of lead researcher Kelly Hoffman on the phone. \"I apologize for the delay,\" she wrote in an email. \"I have been inundated with requests.\"\u003c/p>\n\u003cp>One can imagine.\u003c/p>\n\u003cp>And how many of \u003ca href=\"http://ww2.kqed.org/futureofyou/which-of-these-statements-about-biological-differences-between-blacks-and-whites-are-true/\" target=\"_blank\">these statements\u003c/a> about biological differences between black and white people do \u003cem>you\u003c/em> think are true?\u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp> \u003c/p>\n\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/140326/false-beliefs-about-race-may-lead-doctors-to-minimize-pain-in-blacks","authors":["80"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_847","futureofyou_379","futureofyou_381","futureofyou_756","futureofyou_229"],"featImg":"futureofyou_140499","label":"futureofyou"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Possible-Podcast-Tile-360x360-1.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. 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On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/04/On-Our-Watch-Podcast-Tile-703x703-1.jpg","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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