Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words

Would this work for CPSP(Chronic Post Stroke Pain)?

Your doctor should have had you swearing for 6 years already.

Or maybe your doctor can prescribe swearing in multiple languages.

People Good At Swearing Have This Major Advantage - larger vocabulary

December 2015

A rich vocabulary can protect against cognitive impairment October 2014

 The latest here:

Swearing as a Response to Pain: Assessing Hypoalgesic Effects of Novel “Swear” Words

Richard Stephens^1* and Olly Robertson^2,3

• ¹School of Psychology, Keele University, Keele, United Kingdom
• ²School of Psychology, Keele University, Keele, United Kingdom
• ³Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom

Previous research showing that swearing alleviates pain is extended by addressing emotion arousal and distraction as possible mechanisms. We assessed the effects of a conventional swear word (“fuck”) and two new “swear” words identified as both emotion-arousing and distracting: “fouch” and “twizpipe.” A mixed sex group of participants (N = 92) completed a repeated measures experimental design augmented by mediation analysis. The independent variable was repeating one of four different words: “fuck” vs. “fouch” vs. “twizpipe” vs. a neutral word. The dependent variables were emotion rating, humor rating, distraction rating, cold pressor pain threshold, cold pressor pain tolerance, pain perception score, and change from resting heart rate. Mediation analyses were conducted for emotion, humor, and distraction ratings. For conventional swearing (“fuck”), confirmatory analyses found a 32% increase in pain threshold and a 33% increase in pain tolerance, accompanied by increased ratings for emotion, humor, and distraction, relative to the neutral word condition. The new “swear” words, “fouch” and “twizpipe,” were rated as more emotional and humorous than the neutral word but did not affect pain threshold or tolerance. Changes in heart rate and pain perception were absent. Our data replicate previous findings that repeating a swear word at a steady pace and volume benefits pain tolerance, extending this finding to pain threshold. Mediation analyses did not identify a pathway via which such effects manifest. Distraction appears to be of little importance but emotion arousal is worthy of future study.

Introduction

Swearing, defined as the use of taboo language conveying connotative information (Jay and Janschewitz, 2008), is a near-universal feature of language (van Lancker and Cummings, 1999). Research has shown that repeating a swear word can be an effective way of increasing tolerance for the physical pain of an ice water challenge (Stephens et al., 2009; Stephens and Umland, 2011; Robertson et al., 2017) and the social pain associated with ostracism (Philipp and Lombardo, 2017).

In explaining how swearing brings about these pain reducing effects, one theory posits that swearing brings about a stress-induced analgesia (Stephens and Umland, 2011; Philipp and Lombardo, 2017) via increased autonomic arousal. Consistent with this theory, several studies have shown that swearing provokes an autonomic response, assessed via increased heart rate (Stephens et al., 2009; Stephens and Umland, 2011) and increased skin conductance (LaBar and Phelps, 1998; Jay et al., 2008; Bowers and Pleydell-Pearce, 2011). It is the emotion-provoking aspect of swearing that is thought to underlie this increase in autonomic arousal (Stephens and Allsop, 2012).

It would be of theoretical interest to further assess the importance of emotional arousal as a means by which swearing brings about pain relief. A novel way to assess this would be to test whether a newly made-up “swear” word, chosen because it has potential to elicit an emotional response, produces similar pain reducing effects as swearing.

An alternative theory explaining how swearing brings about pain reducing effects is via attention modulation (Wiech et al., 2008). It is established within the framework of the descending pain inhibitory system that cognitive processes, including distracting attention away from a pain stimulus, can reduce perceived pain (Edwards et al., 2009). The precise mechanism appears to be a combination of inhibiting sensory and emotional brain regions, while at the same time acting in an excitatory capacity on the periaqueductal gray region of the brain where endogenous opioids such as endorphins are produced (Sims-Williams et al., 2017).

One property of swearing that may usefully distract one’s attention from pain is if the word is perceived as humorous or novel. That swearing can be perceived as funny has been shown by Engelthaler and Hills (2018), who had 821 participants rate 5000 English words for humor. The word “fuck” was rated in the top 1% of funniest words. Similarly, swearing is perceived as a novel unit of language, evidenced by findings estimating that swear words make up less than 1% of all speech (Jay, 2009). Given that human attention appears biased toward detecting stimuli that occur less frequently over those occurring more frequently (Horstmann and Herwig, 2016), it would be of theoretical interest to further assess the importance of attention modulation as a means by which swearing brings about pain relief. A novel way to assess this would be to test whether a newly made-up “swear” word, chosen because it has potential to elicit distraction through humor, novelty, or some other aspect, produces similar pain reducing effects as swearing.

The aim of this research study was to generate two new “swear” words, defined as non-pre-existing words that can be used in place of swear words, and to assess the pain-relieving effects of repeating these new words in the context of a cold pressor (ice water) pain challenge. The study provided an opportunity to explore some of the properties of swear words that underlie their psychological effects. Including new “swear” words enabled isolation of some of the properties of swear words in the absence of learned associations that true swear words have been theorized to possess (Jay, 2009).

The new “swear” were generated by an agency working for Nurofen. They were selected for the experiment by a panel consisting of the lead author, a lexicographer, an independent scientist with expertise in swearing, and two lay members. The selection process for the new “swear” words is described later. The cold pressor experiment included the two new words, “fouch” and “twizpipe,” alongside a conventional swear word, “fuck,” included partly as a research replication paradigm. There was also a neutral word control condition to provide a reference against which to assess the effects of the conventional and new swear words. This was a word to describe a table in line with previous similar studies (e.g., Stephens and Umland, 2011). Key aspects of this study were pre-registered on aspredicted.org (#21777) (see Supplementary Materials). Hypotheses (i) to (vii) were included on the pre-registration document and should be considered confirmatory, although please note that, in error, we specified one-way unrelated ANOVAs rather than one-way related ANOVAs. Hypothesis (viii) was not included on the pre-registration document and consequently should be considered exploratory.

It was hypothesized: (i) that emotion ratings would be greater for “fouch” vs. neutral word; (ii) that humor and distraction ratings would be greater for “twizpipe” vs. neutral word; (iii) that emotion, humor, and distraction ratings would be greater for “fuck” vs. neutral word; (iv) that cold pressor pain onset latency (pain threshold) would be increased for “fuck,” “fouch,” and “twizpipe” vs. neutral word; (v) that cold pressor pain tolerance latency would be increased for “fuck,” “fouch” and “twizpipe” vs. neutral word; (vi) that pain perception would be decreased for “fuck,” “fouch” and “twizpipe” vs. neutral word; (vii) that change from resting heart rate would be increased for “fuck” and “fouch” vs. neutral word; and (viii) that the effects of swearing on pain tolerance would be mediated by one or more of the emotion rating, humor rating, or distraction rating scores.

 

Implementing a pain assessment survey and team approach method to effectively assess and treat pain in poststroke patients

Oh well, more wasted research; 'assessment' NOT recovery or results.  NO SOLUTIONS.

 Implementing a pain assessment survey and team approach method to effectively assess and treat pain in poststroke patients

Archives of Rehabilitation Research and Clinical Translation , Volume 2(3) , Pgs. 100058.

NARIC Accession Number: J85215.  What's this?
ISSN: 2590-1095.
Author(s): Alekseyev, Kirill ; Iskander, Peter ; De Santo, Patrick.
Publication Year: 2020.
Number of Pages: 7.

r42

Study created a pain assessment survey to effectively evaluate and treat pain in stroke patients in an inpatient rehabilitation facility. The study was conducted in 2 parts. Part 1 was a preintervention study conducted to assess the prevalence of poststroke pain (PSP) using a pain assessment survey. The correlation between the presence of pain and poststroke patients was assessed, and an enhanced pain assessment was created and implemented in the admission process of poststroke patients. This helped comprise part of the second portion of the study, the postintervention study. Eighty-two patients were included in the preintervention survey, and 102 patients were included in the postintervention survey. Patients with complaints of PSP were intervened immediately upon admission using a team approach. This included all personnel involved in the patient’s care to resolve pain before discharge. Different types of medications and non-medical modalities were used for pain control. The preintervention survey revealed a pain prevalence of 31.7 percent, whereas the postintervention study showed a prevalence of 11.8 percent in poststroke patients on admission. The odds that a poststroke patient would be discharged without pain and with a proper pain assessment and management was 96.2. The team approach to pain management resulted in all patients being successfully treated and discharged pain free. This further demonstrates the importance of using both a pain assessment survey and team approach to assess PSP in poststroke patients.
Descriptor Terms: INTERVENTION, OUTCOMES, PAIN, PAIN MANAGEMENT, PREVALENCE, REHABILITATION, STROKE, TEAMWORK.


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Citation: Alekseyev, Kirill , Iskander, Peter , De Santo, Patrick. (2020). Implementing a pain assessment survey and team approach method to effectively assess and treat pain in poststroke patients.  Archives of Rehabilitation Research and Clinical Translation , 2(3), Pgs. 100058. Retrieved 1/20/2021, from REHABDATA database.


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Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

 Really, you are that fucking stupid that you think assessment is of ANY USE to stroke survivors?  

SOLVE THE PAIN PROBLEM YOU FUCKING IDIOTS.

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will ream me out for making them look bad by being truthful , I look forward to that day. 

The latest here:

Properties of Pain Assessment Tools for Use in People Living With Stroke: Systematic Review

Sophie Amelia Edwards¹, Antreas Ioannou², Gail Carin-Levy³, Eileen Cowey⁴, Marian Brady⁵, Sarah Morton⁶, Tonje A. Sande⁷, Gillian Mead⁶ and Terence J. Quinn^1*

• ¹Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
• ²Internal Medicine Department, Nicosia General Hospital, Strovolos, Cyprus
• ³School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
• ⁴School of Medicine, University of Glasgow, Glasgow, United Kingdom
• ⁵NMAHP Research Unit, Glasgow Caledonian University, Glasgow, United Kingdom
• ⁶Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
• ⁷Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom

Background: Pain is a common problem after stroke and is associated with poor outcomes. There is no consensus on the optimal method of pain assessment in stroke. A review of the properties of tools should allow an evidence based approach to assessment.

Objectives: We aimed to systematically review published data on pain assessment tools used in stroke, with particular focus on classical test properties of: validity, reliability, feasibility, responsiveness.

Methods: We searched multiple, cross-disciplinary databases for studies evaluating properties of pain assessment tools used in stroke. We assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies tool. We used a modified harvest plot to visually represent psychometric properties across tests.

Results: The search yielded 12 relevant articles, describing 10 different tools (n = 1,106 participants). There was substantial heterogeneity and an overall high risk of bias. The most commonly assessed property was validity (eight studies) and responsiveness the least (one study). There were no studies with a neuropathic or headache focus. Included tools were either scales or questionnaires. The most commonly assessed tool was the Faces Pain Scale (FPS) (6 studies). The limited number of papers precluded meaningful meta-analysis at level of pain assessment tool or pain syndrome. Even where common data were available across papers, results were conflicting e.g., two papers described FPS as feasible and two described the scale as having feasibility issues.

Conclusion: Robust data on the properties of pain assessment tools for stroke are limited. Our review highlights specific areas where evidence is lacking and could guide further research to identify the best tool(s) for assessing post-stroke pain. Improving feasibility of assessment in stroke survivors should be a future research target.

Systematic Review Registration Number: PROSPERO CRD42019160679

Available online at: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019160679.

Introduction

Pain is a common problem after stroke (1). Estimates of the frequency of pain vary across studies, depending on the population assessed and whether the focus is incident or prevalent pain. Large cohorts of mild to moderate stroke survivors suggest pain incidence of around 10% (2), while in smaller cohorts figures range from 30% during the first months (3), to 48% at 1 year (4) and 43% at 10 years (5) after stroke.

Post-stroke pain is associated with disability and reduced quality of life (1). It is independently associated with fatigue (6), depression (7) and has been strongly linked with suicidality (8, 9). Pain after stroke can have a variety of etiologies and manifestations, including: shoulder pain, headache, neuropathic pain and exacerbation of pre-existing pain. Pain symptoms can present at any point during stroke recovery and may progress to chronic pain if not recognized and treated appropriately.

The first step in managing post-stroke pain is recognition and measurement. However, management of pain has not always been given the same priority as other aspects of stroke care such as instituting secondary prevention (10). Pain assessment is a complicated task made more challenging in the context of stroke. Since pain is a subjective experience, self-report scales and questionnaires are the most commonly employed pain assessment tools in clinical practice and pain may be part of a more general health related quality of life assessment (11). However, stroke impairments such as cognitive decline and communication issues may make it difficult for stroke survivors to communicate the presence and experience of pain using these tools (12, 13). Other impairments such as visual issues or loss of motor skills may further complicate the use of self-completion questionnaires or visual analog scales.

Accepting these caveats, there is a range of pain assessment tools available that could be used with stroke survivors. Some are generic, some are specific to a certain pain syndrome and some are developed exclusively for stroke. At present there is no consensus on the best approach to assessing post-stroke pain and no standardized tool is recommended for research or practice (14). In the absence of a gold standard pain assessment in stroke survivors and with the great variety of assessment tools available, clinicians may struggle to know the most appropriate approach for their patients. The choice of assessment tools should be guided by evidence, particularly, the psychometric properties of the pain assessment tools available. Classical test features such as validity and responsiveness have been described for certain pain tools, however, equally important are end-user evaluations such as acceptability and feasibility within the person's healthcare setting.

A summary of psychometric properties of pain assessment tools could help clinicians and researchers choose the most appropriate measure, highlighting strengths and limitations and also showing where new evidence is needed. Thus, we conducted a systematic review to compare methods of pain assessment following stroke with a particular focus on properties of validity, reliability, feasibility, and responsiveness.

 

Novel insights(Nope stupid insights) into stroke pain beliefs and perceptions

This is so fucking simple: Solve the pain problem that stroke patients experience. Education is never the answer, unless it is to educate yourself on the only goal in stroke; 100% recovery.

Novel insights(Nope stupid insights) into stroke pain beliefs and perceptions

Topics in Stroke Rehabilitation , Volume 27(5) , Pgs. 344-353.

NARIC Accession Number: J84057.  What's this?
ISSN: 1074-9357.
Author(s): Haslam, Brendon S. ; Butler, David S. ; Carey, Leeanne M..
Publication Year: 2020.
Number of Pages: 10.

Abstract: 

Study examined the beliefs and perceptions of people with stroke who experience chronic pain and compare these to a non-stroke population with chronic pain. A total of 223 participants (106 with stroke and 117 non-stroke) with chronic pain completed an online survey of the Pain Beliefs and Perceptions Inventory. Pain beliefs and perceptions, including perceived causes of pain, were compared across the two groups. The stroke group reported significantly higher pain intensities than the non-stroke group. In addition, they identified the stroke as the primary cause of their pain, whereas the non-stroke group identified a body injury as the primary cause. When compared to the non-stroke group, people with stroke were more likely to report their pain as being constant, demonstrate a lack of understanding regarding cause(s) of their pain, believe less that their actions contribute to their pain, and have greater belief that their pain is permanent. These findings emphasize differences in the beliefs and perceptions associated with pain after stroke, supporting the value of targeted attention from research and therapy perspectives. Significant differences in the pain experienced by stroke and non-stroke groups may reflect a poor understanding of chronic pain following stroke. Future educational programs for stroke survivors should be tailored. (Wrong, wrong, wrong, SOLVE THE PAIN PROBLEM YOU FUCKING IDIOTS, It is not going away thru education.)Targets for future educational interventions are identified and include causes of pain, an understanding of its behavior and potential for improved prognosis.
Descriptor Terms: ATTITUDES TOWARD DISABILITIES, ETIOLOGY, PAIN, PERCEPTION, STROKE.


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Get this Document: https://www.tandfonline.com/doi/full/10.1080/10749357.2019.1701177.

Citation: Haslam, Brendon S. , Butler, David S. , Carey, Leeanne M.. (2020). Novel insights into stroke pain beliefs and perceptions.  Topics in Stroke Rehabilitation , 27(5), Pgs. 344-353. Retrieved 8/19/2020, from REHABDATA database.

Breakthrough toward developing blood test for pain

You'll have to have your doctors followup to see if any of this is usable in CPSP(Chronic Post Stroke Pain).

Breakthrough toward developing blood test for pain

ScienceDaily | February 18, 2019

A breakthrough test developed by Indiana University School of Medicine researchers to measure pain in patients could help stem the tide of the opioid crisis in Indiana and throughout the rest of the nation.

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A study led by psychiatry professor Alexander Niculescu, MD, PhD, and published this week in the Nature journal Molecular Psychiatry tracked hundreds of participants at the Richard L. Roudebush VA Medical Center in Indianapolis, IN, to identify biomarkers in the blood that can help objectively determine how severe a patient's pain is. The blood test, the first of its kind, would allow physicians far more accuracy in treating pain—as well as a better long-term look at the patient's medical future.
"We have developed a prototype for a blood test that can objectively tell doctors if the patient is in pain, and how severe that pain is. It's very important to have an objective measure of pain, as pain is a subjective sensation. Until now we have had to rely on patients self-reporting or the clinical impression the doctor has," said Niculescu, who worked with other Department of Psychiatry researchers on the study. "When we started this work it was a farfetched idea. But the idea was to find a way to treat and prescribe things more appropriately to people who are in pain."
During the study, researchers looked at biomarkers found in the blood—in this case, molecules that reflect disease severity. Much as glucose serves as a biomarker to diabetes, these biomarkers allow doctors to assess the severity of the pain the patient is experiencing and provide treatment in an objective, quantifiable manner. With an opioid epidemic raging throughout the state and beyond, Niculescu said never has there been a more important time to administer drugs to patients responsibly.

• See Also: Opioid use in knee or hip osteoarthritis: A region-wide population-based cohort study

"The opioid epidemic occurred because addictive medications were overprescribed due to the fact that there was no objective measure whether someone was in pain or how severe their pain was," Niculescu said. "Before, doctors weren't being taught good alternatives. The thought was that this person says they are in pain, let's prescribe it. Now people are seeing that this created a huge problem. We need alternatives to opioids, and we need to treat people in a precise fashion. This test we've developed allows for that."
In addition to providing an objective measure of pain, Niculescu's blood test helps physicians match the biomarkers in the patient's blood with potential treatment options. Like a scene out of CSI, researchers utilize a prescription database—similar to fingerprint databases employed by the FBI—to match the pain biomarkers with profiles of drugs and natural compounds cataloged in the database.
"The biomarker is like a fingerprint, and we match it against this database and see which compound would normalize the signature," said Niculescu, adding that often the best treatment identified is a non-opioid drug or compound. "We found some compounds that have been used for decades to treat other things pair the best with the biomarkers. We have been able to match biomarkers with existing medications or natural compounds, which would reduce or eliminate the need to use the opioids."
In keeping with the Indiana University Grand Challenge Precision Health Initiative launched in June 2016, this study opens the door to precision medicine for pain. By treating and prescribing medicine more appropriately to the individual person, this prototype may help alleviate the dilemmas that have contributed to the current opioid epidemic.
"In any field, the goal is to match the patient to the right drug, which hopefully does a lot of good and very little harm," Niculescu said. "But through precision health, by having lots of options geared toward the needs of specific patients, you prevent larger problems, like the opioid epidemic, from occurring."
Additionally, study experts discovered biomarkers that not only match with non-addictive drugs that can treat pain, but can also help predict when someone might experience pain in the future—helping to determine if a patient is exhibiting chronic, long-term pain which might result in future emergency room visits.
"Through precision medicine you're giving the patient treatment that is tailored directly to them and their needs," Niculescu said. "We wanted first to find some markers for pain that are universal, and we were able to. We know, however, based on our data that there are some markers that work better for men, some that work better for women. It could be that there are some markers that work better for headaches, some markers that work better for fibromyalgia, and so on. That is where we hope to go with future larger studies."
The study was supported by a National Institutes of Health (NIH) Director's New Innovator Award and a VA Merit Award. Moving forward, Niculescu's group looks to secure more funding through grants or outside philanthropy to continue and accelerate these studies—with the hopes of personalizing the approach even more and moving toward a clinical application. A self-described longshot at the start, Niculescu said that the work his group has done could have a major impact on how doctors around the world treat pain in the future.

• See Also: Serious health concerns missed in older adults

"It's been a goal of many researchers and a dream to find biomarkers for pain," Niculescu said. "We have come out of left field with an approach that had worked well in psychiatry for suicide and depression in previous studies. We applied it to pain, and we were successful. I give a lot of credit for that to my team at Indiana University School of Medicine and the Indianapolis Veterans Affairs (VA), as well as the excellent environment and support we have."

To read more, click here.

Combating Post-Stroke Pain to Improve Recovery

But no solutions provided.
https://health.usnews.com/health-care/patient-advice/articles/2018-06-19/combating-post-stroke-pain-to-improve-recovery

In the throes of a heart attack, most people experience pain or discomfort. Chest pain is a common, classic symptom, of course – but the pain may be felt in other areas from the arms to the stomach, according to the American Heart Association, and women are more likely to experience symptoms such as back or jaw pain. By comparison, when someone is having a stroke, they’re not likely to be in pain.

“You may get numbness, but you almost never get pain that comes on with the stroke,” says Dr. Joseph Broderick, a spokesperson for the American Stroke Association, which is part of AHA, and director of the University of Cincinnati Gardner Neuroscience Institute. Yet, experts say many survivors suffer from pain that takes hold after a stroke. Estimates vary greatly, but anywhere between 10 percent to half of stroke survivors report the new onset of pain following a stroke, depending on factors such as the severity of the stroke and the part of the brain affected. While some experience post-stroke pain immediately, the discomfort often doesn’t start until weeks or even months following. That can make it an afterthought in treatment. “Pain following stroke is commonly reported but often incompletely managed, which prevents optimal recovery,” notes Dr. Andrew Treister of the University of California, San Diego and co-author of a paper on post-stroke pain published last year in PM&R, the scientific journal of the American Academy of Physical Medicine and Rehabilitation.

A host of different factors can contribute to post-stroke pain. “It’s not just one thing usually,” says Dr. Aaron Bunnell, an assistant professor of rehabilitation medicine at the University of Washington School of Medicine, who treats patients at UW Medicine’s Comprehensive Stroke Center at Harborview Medical Center. The multifaceted nature of post-stroke pain can make diagnosing and treating it more difficult, particularly when it’s not managed by a health team or at a medical center specializing in stroke rehab.

[See: 10 Ways to Lower Your Risk of Stroke.]

There are several types of PSP. That includes central post-stroke pain, or central pain syndrome, caused by damage to certain parts of the brain, like the thalamus, that affects sensory processing. This can cause and increase the pain a person feels. In addition, complex regional pain syndrome – a type of chronic pain – can affect an arm or leg following an injury or heart attack or stroke and occasionally gets worse and spreads to other areas of the body, like an opposite limb. Some stroke survivors experience pain related to spasticity, in which muscles – for example of the arm – involuntarily contract or spasm in a way that’s painful. And some have post-stroke joint pain – particularly in the shoulder – like when weakness in the arm leaves the joint vulnerable to partial dislocation, or subluxation. Even PSP that may seem straightforward like shoulder pain can have various causes – not only mechanical, but neurological. For example, the involuntary contraction that characterizes spasticity, caused by damage to the brain sustained during a stroke, can contribute. “So the muscles, instead of being flaccid, are now tight, and will begin to put the shoulder out of joint itself,” Bunnell points out. That can cause significant discomfort in addition to the pain for the spasticity itself.

Treatment of PSP depends on the type of pain and the underlying cause. For example, with spasticity, it may be treated with medication, such as baclofen, which helps relax muscles. In some cases Botox is injected into the affected muscles, Broderick says, so they’re not so contracted and painful, and to help with function. And electrical stimulation may be used to get the muscle to contract and build some strength and tone, Bunnell adds.

With muscle or joint weakness, it’s important to provide support as necessary – such as through bracing – and to practice caution, like ensuring caregivers don’t take a patient by a weak arm. But experts don’t recommend simply keeping it stationary. Rather it’s key to work on getting function back to the extent possible. “We use physical therapy to work on strengthening of the shoulder, range of motion without causing pain, and helping them to get a maximal recovery of that strength to improve their pain,” Bunnell says.

[See: 9 Reasons You Should Return to Work After a Stroke.]

The complexity of PSP and, specifically, questions still surrounding the physiological underpinnings with central post-stroke pain and complex regional pain syndromes can complicate treatment. Both pain syndromes are commonly treated with medication, like gabapentin – an anticonvulsant drug that’s used to treat seizure disorders and nerve damage – along with other medications such as antidepressants. But, particularly for central post-stroke pain, there’s no drug that reliably makes it go away. “None of them work great – and often you’re stuck with trying to keep the patient as active as possible, and trying to live with pain, to treat any mood disorder associated with it, which sometimes can make the pain worse,” Treister says. “But it’s a hard pain to treat.”

Part of taking a big picture approach to treating PSP in general includes treating depression – where present. “Depression is very common after stroke, and depression and pain can definitely be linked – and often depression worsens pain,” Bunnell says. “So making sure that you’re managing any depression or anxiety that are a result of the stroke, or pre-existing – that often is very helpful for managing pain as well.”

For some with central pain syndrome, treatment involves undergoing deep brain stimulation, or having electrodes implanted to deliver electrical impulses to the brain. The review of PSP-related research that was published in PM&R last year noted that a meta-analysis of a small group of patients who’d had electrodes permanently implanted through deep brain stimulation found more than half were able to achieve long-term pain relief. But Broderick says overall results from the stimulation procedure have been inconsistent.

Despite the challenges of treating PSP – particularly central pain syndrome – experts urge stroke survivors to work with specialists in stroke rehab to properly diagnose their pain and determine the best approaches to manage it.

[See: 4 Subtle Signs of Depression in Men.]

Beyond the obvious discomfort, PSP can have an impact on a person’s ability to engage in rehab and to recover after a stroke. “It affects your happiness and just well-being,” Bunnell says. “It affects your functional outcomes – so your ability to participate in therapies, ability to do your own self-care; and it affects other things like sleep and mood.” That’s all the more reason to make sure the pain is addressed.

Michael O. Schroeder, Staff Writer

Assessing and treating pain associated with stroke, multiple sclerosis, cerebral palsy, spinal cord injury and spasticity. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation

Only 28 pages, TLDR(Too Long, Didn't Read). This is your doctors responsibility to know such stuff. 

Assessing and treating pain associated with stroke, multiple sclerosis, cerebral palsy, spinal cord injury and spasticity. Evidence and recommendations from the …

 

Chapter 5; Pain in the Stroke Rehabilitation Patient

Have at it.

Pain in the Stroke Rehabilitation Patient

Brains in Pain Cannot Learn!

Your doctor should be taking Dr. Lori Desautels's  ideas to heart and prevent the stress response in their stroke survivors. 
https://www.edutopia.org/blog/brains-in-pain-cannot-learn-lori-desautels

Educators want nothing more than for our students to feel successful and excited to learn, and to understand the importance of their education. We want our students' attention and respect to match our own. I believe that most if not all of our students desire the same, but walking through our classroom doors are beautifully complex youth who are neurobiologically wired to feel before thinking.

Carrying In

Educators and students are carrying in much more than backpacks, car keys, conversations, partially-completed homework, and outward laughter. Buried deep in the brain's limbic system is an emotional switching station called the amygdala, and it is here that our human survival and emotional messages are subconsciously prioritized and learned. We continually scan environments for feelings of connectedness and safety. I am learning that the students who look oppositional, defiant, or aloof may be exhibiting negative behavior because they are in pain and presenting their stress response.
Over 29 percent of young people in the U.S., ages 9-17, are affected by anxiety and depression disorders (PDF). The thinking lobes in the prefrontal cortex shut down when a brain is in pain.

Trauma and the Brain

What is trauma? When we hear this word, we tend to think of severe neglect or abusive experiences and relationships. This is not necessarily true. A traumatized brain can also be a tired, hungry, worried, rejected, or detached brain expressing feelings of isolation, worry, angst, and fear. In youth, anger is often the bodyguard for deep feelings of fear. Trauma-filled experiences can be sudden or subtle, but the neurobiological changes from negative experiences cause our emotional brain to create a sensitized fear response. When we feel distress, our brains and bodies prioritize survival, and we pay attention to the flood of emotional messages triggering the question, "Am I safe?" We react physiologically with an irritated limbic system that increases blood pressure, heart rate, and respiration with an excessive secretion of the neuro hormones cortisol and adrenaline pumping through our bodies. Chronic activation of the fear response can damage other parts of the brain responsible for cognition and learning.
We are all neurobiologically wired for social connection and attachment to others. When children don't receive healthy connections in early development, the brain rewires and adapts just as readily to unhealthy environments. If brain development is disrupted by adversity at any age, but especially in early development (PDF), the skills of problem solving, reflection, and emotional regulation are compromised and diminished. Children and adolescents need stimulation and nurturance for healthy development and attachment. Students whose development is disrupted often walk through the doors of our schools mistrusting adults.

Prime the Brain

To learn and problem solve, we must prime the brain for engagement and feelings of safety. In recent years, there has been a significant emphasis on Common Core proficiency while teacher training has often lost sight of the impact of understanding brain development in students. The almond-shaped clusters of neurons resting deep in each temporal lobe must be quieted if learning and well-being are to be exercised and addressed. Educators too need to be aware of our brain states and subconscious emotional triggers that could throw us into a power struggle and a stress-response state as we interface with our students.
What can we do to create calm and safe brain states within ourselves and within the students who walk in with an activated fear response?
We first must understand that feelings are the language of the limbic system. When a student in stress becomes angry or shut down, he or she won't hear our words. Talking a student through any discipline procedure or thought reflection sheet in the heat of the moment is fruitless. Here are three ways to calm the stress response -- two of them through immediate action, and the third by a brief science lesson.

1. Movement

Movement is critical to learning while calming the stress and fear response. Teachers and students together could design a space, a labyrinth of sorts, where students can walk or move to relieve the irritation of the amygdale. Physical activities such as push-ups, jogging in place, jumping jacks, and yoga movements help to calm the limbic brain and bring the focus back to learning and reasoning.

2. Focused Attention Practices

Focused attention practices teach students how to breathe deeply while focusing on a particular stimulus. When we take two or three minutes a few times each day or class period and teach students how to breathe deeply, we are priming the brain for increased attention and focus. These practices might also include a stimulus such as sound, visualization, or the taste of a food. The focused attention increases an oxygenated blood and glucose flow to the frontal lobes of the brain where emotional regulation, attention, and problem solving occur.

3. Understanding the Brain

Teaching students about their amygdala and fear response is so empowering. When we understand that this biology is many thousands of years in the making, hardwired to protect us, our minds begin to relax through knowing that our reactions to negative experiences are natural and common. A middle-school teacher and her students have named the amygdala "Amy G. Dala." By personifying this ancient, emotionally-driven structure in our brains, the students are befriending their fear responses and learning how to lessen negative emotion. We cannot always control the experiences in our lives, but we can shift how we respond, placing the science of our brains in the driver's seat of discipline!
Have you recognized students experiencing emotional pain? How have you helped them overcome this?

Dr. Lori Desautels's Profile

How much does it hurt? Startup’s device objectively measures pain

Research needed here to see if CPSP registers pain the same way. Have your doctor start up a clinical research trial on this.

How much does it hurt? Startup’s device objectively measures pain

/ Jun 10, 2015 at 8:03 PM

Is pain subjective? Does one person feel it the same way as another? In general clinical practice, we don’t really know.  Right now, our approach to gauging how much something hurts is rudimentary at best – a 0-10 pain scale.
Philadelphia startup PainQx is developing software that uses EEG measurements to objectively answer the question: How much does it hurt?
“When patients are presenting pain, doctors are left with nothing more than an educated guesstimate,” CEO Frank Minella said. “Inaccurate pain measurement leads to inaccurate pain management.”
The technology is licensed from the NYU School of Medicine. Thus far, PainQx has raised about $1.3 million, and is looking for a $375,000 angel round – and then a $4.5 million Series A.

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Overtreatment and addiction to pain meds are, after all, a prevailing epidemic in the U.S. The estimated costs for this run between $560 billion to $630 billion, according to a book called Pain in America: A Blueprint for Transforming Prevention, Care, Education and Research, which writes:

We found that the annual cost of pain was greater than the annual costs in 2010 dollars of heart disease ($309 billion), cancer ($243 billion), and diabetes ($188 billion) and nearly 30 percent higher than the combined cost of cancer and diabetes.

The perception of all these aches and agony is, after all, “all in your head,” Minella said. It’s all about how the brain reacts to injury.
Advances in brain mapping is allowing PainQx to study electroactivity data from an EEG headset to map out a patient’s pain reaction. Understanding the pain matrix is already well-documented in literature: Certain regions and subregions of the brain light up with electrical activity when a patient’s in pain, which can be captured by EEG, MRI and PET scans.
For the purposes of a scalable device, EEG is the best approach for gauging pain levels, Minella said.
The ultimate goal of PainQx is to change the standard of care in pain assessment, Minella said. But he’s got an incremental plan to validate his tool and bring it to fruition.
The plan is to start out by working with CROs and pharmaceutical companies for pain management clinical trials. The average pain clinical trial cost, Minella says, is about $105 million – so the use-case of such a device will be to improve data, reduce costs and have a cleaner population of patients.
The idea is to next transition into nursing homes and assisted living centers – to be used among patients whose ability to communicate pain is limited.
The case for payors and providers here is cost reduction (the average cost to treat a chronic or neuropathic pain patient is $19,000 per year), building out objective quality measures and monitoring data. And, of course, the ability to reduce, say, opioid abuse.
“If this goes down properly, it really could become the standard of care,” Minella said.

New analysis of spider venom reveals seven promising compounds with the potential to relieve chronic pain

Send your doctor after this to see if this could possibly relieve CPSP.
http://www.alphagalileo.org/ViewItem.aspx?ItemId=150284&CultureCode=en
New research shows that seven compounds of the countless found in spider venom block a key step in the body’s ability to pass pain signals to the brain. The hunt for a medicine based on just one of these compounds, which would open up a new class of potent painkillers, is now a step closer according to new research published in the British Journal of Pharmacology.
Pain that cannot be controlled can ruin people’s lives. One in five people worldwide currently suffer from chronic pain, and existing pain treatments often fail to provide relief. The economic burden is huge, with chronic pain in the USA alone estimated to cost around $600 billion a year, greater than the combined economic cost of cancer, diabetes and stroke.
People sense that part of their body is hurting when nerves from the affected area send signals to the brain through what is called the pain pathway. “A compound that blocks Nav1.7 channels is of particular interest for us. Previous research shows indifference to pain among people who lack Nav1.7 channels due to a naturally-occurring genetic mutation – so blocking these channels has the potential of turning off pain in people with normal pain pathways,” says research team leader Professor Glenn King from The University of Queensland’s Institute for Molecular Bioscience, Australia.
Part of the search for new medicines has focused on the world’s 45,000 species of spiders, many of which kill their prey with venoms that contain hundreds – or even thousands – of protein molecules. Some of these molecules block nerve activity. “A conservative estimate indicates that there are nine million spider-venom peptides, and only 0.01% of this vast pharmacological landscape has been explored so far,” says researcher Dr Julie Kaae Klint. The challenge was to build a research method that could search through this huge number of peptides, looking for the ones that could be useful.
Taking up this challenge, the research team built a system that could rapidly analyse the compounds in spider venoms. Using their novel approach, venoms from 206 species of spider were screened, revealing that 40% of the venoms contained at least one compound that blocked human Nav1.7 channels. Of the seven promising compounds identified, they discovered one that was particularly potent, and also had a chemical structure that suggested it would have high levels of chemical, thermal, and biological stability, which would be essential for administering a new medicine. Together these properties make it particularly exciting as a potential painkiller.
“Untapping this natural source of new medicines brings a distinct hope of accelerating the development of a new class of painkillers that can help people who suffer from chronic pain that cannot be treated with current treatment options,” says Dr Klint. The novel screening approach used to isolate the protein molecules from spider venoms could also be applied to other compounds, opening up hope more widely for new and better medicines.

• Full bibliographic informationFull citation: Seven novel modulators of the analgesic target Nav1.7 uncovered using a high-throughput venoms-based discovery approach. Julie K. Klint, Jennifer J. Smith, Irina Vetter, Darshani B. Rupasinghe, Sing Yan Er1, Sebastian Senff, Volker Herzig, Mehdi Mobli, Richard J. Lewis, Bosmans F, & King GF. BJP. DOI: 10.1111/bph.13081
  URL Upon Publication: doi.wiley.com/10.1111/bph.13081

Cannabinoids: clearing the smoke on pain, inflammation and neurodegeneration

Ask your doctor what use this is for your stroke recovery.
http://onlinelibrary.wiley.com/doi/10.1111/bph.12642/full

This themed section of BJP arises from the 6^th European Workshop on Cannabinoid Research held in Dublin, Ireland from 18–20 April 2013. The section brings together 3 reviews and 10 research articles, presenting a range of work across the cannabinoid field.

The review article by Fagan et al. (2014) addresses the impact of endogenous, plant-derived and synthetic cannabinoids on neuronal viability. This review summarizes common mechanisms of neurodegeneration (including mitochondrial dysfunction, neuroinflammation and excitotoxicity) in three prominent age-related neurodegenerative disorders, Alzheimers' disease, Parkinson's disease and Huntington's disease. The review focuses on literature highlighting the cannabinoid system as a bona fide therapeutic target against such neurodegenerative processes. In addition, this review brings us up-to-date on the close links between the endocannabinoid system, ageing and the process of adult neurogenesis.

Stanley and O'Sullivan (2014) review the vascular targets of cannabinoids. They examine the evidence for the range of receptors activated by cannabinoids in perfused vascular beds or isolated arteries. Direct targets of synthetic, plant-derived or endogenous cannabinoids include CB₁, CB_e, TRPV1, peroxisome proliferator-activated receptors (PPARs), CB₂, GPR55 and 5-HT_1A receptors. Prostanoid receptors and the calcitonin gene-related peptide (CGRP) receptor can also indirectly mediate the vascular response to cannabinoids. Typically cannabinoids have vasorelaxant effects, although vasoconstriction has also been observed in some instances. Animal and human studies are reviewed.

The third review article discusses one of the most abundant endocannabinoids, 2-arachidonylglycerol (2-AG), and summarizes the latest major discoveries associated with the complex pathways leading to 2-AG synthesis and metabolism in the central nervous system (CNS) (Murataeva et al., 2014). This review addresses the spatial and temporal expression of diacylglycerol lipases (DAGL) in the CNS, the most heavily studied pathway for 2-AG synthesis. Intriguing questions regarding 2-AG metabolizing enzymes are considered, including their activity in different cellular compartments and their contribution to endogenous 2-AG-based signalling. The review highlights that the various enzymes for synthesizing and degrading 2-AG represent potential therapeutic targets for neurodegenerative and inflammatory diseases.

Research on the function of 2-AG has been facilitated in recent years by the availability of some selective and potent inhibitors of the catabolising enzyme monoacylglycerol lipase (MAGL). One such inhibitor is the compound KML29 and Ignatowska-Jankowska et al. (2014) present novel data herein on the effects of this MAGL inhibitor in mouse models of inflammatory (carrageenan) and neuropathic (sciatic nerve injury) pain. Their results show that systemic administration of KML29 attenuates carrageenan-induced paw oedema and reverses carrageenan-induced mechanical allodynia. Tolerance to these effects of KML29 and CB₁ receptor desensitization developed after repeated administration of high doses. Moreover, KML29 partially reversed sciatic nerve injury-induced allodynia and prevented diclofenac-induced gastric haemorrhages, without eliciting cannabimimetic effects in the tetrad test. These preclinical data suggest that MAGL inhibitors show promise as novel analgesics with a favourable side-effect profile.

More at link.

Nerve block works for stroke shoulder pain

But is this just disguising the damage being done? Have we even determined if the pain is real or not? I'm sure your doctor reads  every issue of Rheumatology Update and will tell you about this shortly.
http://www.rheumatologyupdate.com.au/latest-news/nerve-block-works-for-stroke-shoulder-pain


Shoulder pain was common following stroke, affecting up to 25% of patients, yet there was no good treatment for post-stroke shoulder pain, Dr Shanahan told Rheumatology Update.
The rheumatologists from Flinders University found neurologists were coming to them for a solution, so they decided to conduct a study into the effectiveness of nerve blocks in these patients.
They randomised 32 patients to receive a nerve block injection, and 32 patients to placebo.
At week one, four and 12 the SSNB group had a mean VAS reduction of »37mm with a 18mm difference between the intervention and control group, albeit with wide confidence intervals (CI 3-29 at 12 weeks).
The number needed to treat with SSNB to reduce one stroke survivor’s pain by 50% at four weeks and 12 weeks was four, the researchers reported.
“Patients will most likely only need one injection, as pain relief tended to last longer than 12 weeks, and most shoulder pain will settle after 12 months,” Dr Michael Shanahan told Rheumatology Update.
But the researchers were not sure why nerve block worked, and they were currently using transcranial nerve stimulation in a bid to understand the mechanism behind its effectiveness, Dr Shanahan said.
They were also looking at the effectiveness of nerve blocks in other types of stroke, frozen shoulder and in motor neurone disease.

Suprascapular Nerve Block for Shoulder Pain in the First Year After Stroke

Is this a possibility for helping your recovery along? You will need to bring it up to your doctors because they won't know about it.
http://stroke.ahajournals.org/content/44/11/3136.abstract.html?etoc

1. Zoe Adey-Wakeling, BMBS;
2. Maria Crotty, PhD;
3. E. Michael Shanahan, PhD

+ Author Affiliations

1. From the Department of Rehabilitation and Aged Care (Z.A.-W., M.C.) and Department of Rheumatology (E.M.S.), Flinders University, Daw Park, South Australia.

1. Correspondence to Zoe Adey-Wakeling, BMBS, Department of Rehabilitation and Aged Care, C Block, Repatriation General Hospital, Daws Road, Daw Park SA 5041. E-mail zoe.adey-wakeling@health.sa.gov.au

Abstract

Background and Purpose—Shoulder pain is a common complication after stroke that can impede participation in rehabilitation and has been associated with poorer outcomes. Evidence-based treatments for hemiplegic shoulder pain are limited. Suprascapular nerve block (SSNB) is a safe and effective treatment of shoulder pain associated with arthritic shoulder conditions, but its usefulness in a stroke population is unclear.

Methods—We undertook a randomized controlled trial assessing the effectiveness of SSNB in a population of 64 stroke patients (onset < 1 year) with hemiplegic shoulder pain. The primary outcome was pain measured on a visual analogue scale (VAS). Secondary outcomes were disability (Modified Rankin Scale, Croft Disability Index) and quality of life (EuroQol Health Questionnaire). All participants were assessed before randomization, and at 1, 4, and 12 weeks postintervention. Both groups continued with routine therapy.

Results—Although both intervention and control groups demonstrated reduction in pain score, participants who received SSNB consistently demonstrated superior, statistically significant pain reduction compared with placebo. Mean VAS reduction in the SSNB group was >18 mm greater than participants receiving placebo injection. The number needed to treat with SSNB to reduce 1 stroke survivor’s pain by 50% at 4 weeks is 4. No significant differences in function or quality of life were observed. No adverse events were reported.

Conclusions—Suprascapular nerve block is a safe and effective treatment for patients with hemiplegic shoulder pain.

Clinical Trial Registration—URL: http://www.anzctr.org.au. Unique identifier: ACTRN12609000621213.