An end to needle phobia: Device could make painless injections possible

"As many as 1 in 10 people experience needle phobia, which may have negative consequences, such as decreasing the rate of vaccinations and blood donation," said William McKay, M.D., lead author of the study. Credit: © uwimages / Fotolia

Imagine no tears during infant vaccines and no fear of the needle for those old enough to know what's coming. Such painless injections could be possible with a device that applies pressure and vibration while the needle is inserted in the skin, according to a study presented at the ANESTHESIOLOGY™ 2014 annual meeting.

"As many as 1 in 10 people experience needle phobia, which may have negative consequences, such as decreasing the rate of vaccinations and blood donation," said William McKay, M.D., lead author of the study and a professor of anesthesiology in perioperative medicine and pain management at the University of Saskatchewan, Saskatoon, Canada. 

"Our early research suggests that using a device that applies pressure and vibration before the needle stick could help significantly decrease painful sensations by closing the 'gate' that sends pain signals to the brain."

Researchers studied the use of pressure, vibration, and cooling or warming in 21 adults poked in the shoulder by a plastic needle that doesn't break the skin but produces needle-like pain. They tested different levels of pressure, vibration and temperature to determine the amount that provided the most benefit. The perception of pain was significantly decreased when a specific amount of pressure and vibration was applied to the site for 20 seconds prior to using the plastic needle. The addition of heat added a small benefit, but it wasn't significant. The study should be repeated in children, who may experience pain differently, said Dr. McKay. The addition of heat or cold might be more beneficial, he said.

While commercial devices that include some of these features are available, they could be improved by incorporating the additional features tested in this and other studies, he said. They could be used to prevent pain prior to providing intravenous (I.V.) treatment, the drawing or donating of blood, or administering vaccinations.

The concept likely works by distraction as well as employing the gate-control theory of pain, in which these sensations (pressure, vibration and potentially temperature) close the gate that allows the brain to register pain.

Source: American Society of Anesthesiologists (ASA)

Back pain killing your sex life? Study reveals best positions to save your spine

Contrary to popular belief, spooning is not always the best sex position for those with a bad back, according to new research from the University of Waterloo. For the first time ever, scientists have successfully documented the way the spine moves during sex and discovered exactly why certain positions are better than others when it comes to avoiding back pain. The pioneering study combined infrared and electromagnetic motion capture systems to track how ten couples' spines moved when attempting five common sex positions. The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient's pain. Pictured: Professor Stuart McGill demonstrates the motion of the spine during sex.  
Credit: University of Waterloo

Contrary to popular belief, spooning is not always the best sex position for those with a bad back, according to new research from the University of Waterloo.

For the first time ever, scientists have successfully documented the way the spine moves during sex and discovered exactly why certain positions are better than others when it comes to avoiding back pain.

"Any family doctor will tell you that couples often ask them how to manage their back pain during and after sex. Many couples will remain celibate because one night of love-making can lead to months of back agony," said Professor Stuart McGill, of Waterloo's Faculty of Applied Health Sciences. "Until now, doctors have never had any hard science to base their recommendations upon."

The pioneering study combined infrared and electromagnetic motion capture systems -- like those used in the creation of video games -- to track how 10 couples' spines moved when attempting five common sex positions. The findings were used to create an atlas, or set of guidelines, that recommends different sex positions and thrusting techniques based on what movements trigger a patient's pain.

"Before now, spooning was often recommended by physicians as the one position that fit all. But as we've discovered, that is not the case," said Natalie Sidorkewicz, a PhD candidate at Waterloo and lead author on the paper. "Sex positions that are suitable for one type of back pain aren't appropriate for another kind of pain."

The atlas recommends that men who are flexion-intolerant -- meaning those whose back pain is made worse by touching their toes or sitting for long periods of time, for example -- replace spooning with doggy-style sex. The guide recommends that these men use a hip-hinging motion rather than thrusting with their spines.

"For the first time ever, we now have very solid science to guide clinicians on their recommendations for patients who suffer debilitating back pain, but still want to be intimate," said Sidorkewicz. "This has the potential to improve quality of life -- and love-life -- for many couples."

According to Statistics Canada, four of every five people will experience at least one episode of disabling low back pain in their lifetime. Up to 84 per cent of men with low back pain and 73 per cent of women report a significant decrease in the frequency of intercourse when suffering back pain.

The study also shed light for the first time on the mechanics of the male orgasm. Electrodes hooked up to the male participants' muscles revealed that it is abdominal and buttock, not back muscles, that are most active during orgasm. Spine motion, on the other hand, varied with the individual. For some males, a drastic increase in flexion or extension was seen, while for others spine motion did not change much at all.

"Many of the back pain patients that we see have told us that they experience elevated levels of pain during orgasm, to the point where they will avoid having one during sex with their partner," said Sidorkewicz. "These initial findings help us to begin to understand what might be provoking their pain during the moment of climax."

A paper documenting male spine movement was published in the journal Spine. Female findings are expected to be published in the coming months. The next phase of the study will involve recruiting patients with hip pain and additional categories of back pain to further develop the guidelines.

Source: University of Waterloo

Targeting fatty acids may be treatment strategy for arthritis, leukemia

The bone marrow of mice with normal ether lipid production (top) contains more white blood cells than are found in the bone marrow of mice with ether lipid deficiency (bottom).
Credit: Washington University School of Medicine

Enzymes linked to diabetes and obesity appear to play key roles in arthritis and leukemia, potentially opening up new avenues for treating these diverse diseases, according to new research at Washington University School of Medicine in St. Louis.

Working with genetically engineered mice, the researchers discovered that the same enzymes involved in turning carbohydrates into the building blocks of fats also influence the health of specialized white blood cells called neutrophils. Neutrophils are the most abundant type of white blood cell and a hallmark of inflammation, which is a key component of rheumatoid arthritis. Abnormally high levels of neutrophils also are common in patients with leukemia.

The study is published Jan. 6 in the journal Cell Metabolism.

"The link between these enzymes and neutrophils was a big surprise," said first author Irfan J. Lodhi, PhD, assistant professor of medicine. "We had never thought about treating rheumatoid arthritis or leukemia by targeting enzymes that produce fatty acids, but this work supports that line of thinking."

In the study, mice that couldn't make enzymes needed to produce a certain type of fat abruptly lost weight and developed extremely low white blood cell counts, with very few neutrophils. Without this fat, called an ether lipid, neutrophils died.

That discovery could lead to the targeting of ether lipids as a way to reduce the number of neutrophils in inflammatory diseases and leukemias. The researchers believe limiting, rather than eliminating, ether lipids may be the best approach because neutrophils are important infection fighters.

"This may be a pathway to limit inflammation," said senior investigator Clay F. Semenkovich, MD, the Herbert S. Gasser Professor of Medicine. "If we could reduce the activity of these enzymes without eliminating them entirely, it could lower the levels of ether lipids and potentially help patients with leukemia and inflammatory diseases such as arthritis."

Semenkovich, also a professor of cell biology and physiology and director of the Division of Endocrinology, Metabolism and Lipid Research, said the enzymes specifically target neutrophils without affecting other immune cells.

"So ether lipids appear to be a very precise target," he said.

Working with Daniel Link, MD, the Alan A. and Edith L. Wolff Distinguished Professor of Medicine, the researchers learned that inactivating the enzymes didn't harm the precursors of neutrophils; only mature neutrophils were killed.

That could mean strategies to limit the production of ether lipids might lower neutrophil levels only temporarily so that when treatment stops, a patient's neutrophil count gradually would rise, allowing the immune system to return to normal.

Source: Washington University in St. Louis

Small, fast, and crowded: Mammal traits amplify tick-borne illness

Chipmunks are small-bodied animals with fast lives and dense populations. When ticks feed on them, they are more likely to pick up multiple disease-causing pathogens. Credit: © dwags / Fotolia

In the U.S., some 300,000 people are diagnosed with Lyme disease annually. Thousands also suffer from babesiosis and anaplasmosis, tick-borne ailments that can occur alone or as co-infections with Lyme disease. According to a new paper published in PLOS ONE, when small, fast-living mammals abound, so too does our risk of getting sick.

In eastern and central North America, blacklegged ticks are the primary vectors for Lyme disease, babesiosis, and anaplasmosis. The pathogens that cause these illnesses are widespread in nature; ticks acquire them when they feed on infected animals.

Richard S. Ostfeld, the paper's lead author and a scientist at the Cary Institute of Ecosystem Studies, has researched the ecology of Lyme disease since 1992. "A pattern emerged in our long-term studies. Ticks that fed on certain rodents and shrews were much more likely to pick up multiple pathogens, making the environment riskier for people."

To investigate why mammals differ in their 'reservoir competence' or ability to transmit pathogens to ticks, Ostfeld and his co-authors from Bard College, Oregon State University, the University of South Florida, and EcoHealth Alliance took a two-pronged approach.

First, they looked at life history traits for nine mammals known to harbor Lyme disease, babesiosis, and anaplasmosis. Attributes like body size, litter size, and life span were taken into consideration.

Then they looked at the role of mammal population density. As 'sit and wait' parasites, ticks are much more likely to encounter animals with dense populations. This, in turn, could help pathogens evolve to exploit specific hosts, resulting in more effective transmission rates.

For Lyme disease and anaplasmosis, fast life history features were a strong predictor of an animal's ability to transmit infection to ticks. Body size was inversely related to reservoir competence. Raccoon, skunk, opossum, squirrel, and deer infected fewer ticks than their mouse, chipmunk, and shrew counterparts.

Ostfeld notes, "This is consistent with past research on Lyme disease, West Nile virus, and Eastern Equine encephalitis. There is evidence that animals that mature early and have frequent, large litters invest less in some immune defenses, making them better pathogen hosts."

Population density was the best predictor of species' abilities to transmit all three pathogen groups, with animals that ticks encountered most frequently being the most effective at transferring infection. Co-author Felicia Keesing of Bard College explains, "Fast life history and high population density often go hand-in-hand. In rodents and shrews, pathogen adaptation and poor immune defense may be working together to amplify disease spread."

With Ostfeld concluding, "In our struggle to manage the ever-growing list of tick-borne diseases, we need to understand which animals magnify human disease risk. Our results suggest when generalist pathogens emerge, small mammals with large populations and a fast pace of life warrant careful monitoring."

Source: Cary Institute of Ecosystem Studies

Physicians seeing increase in brown recluse spider bites

The brown recluse spider has a violin-shaped marking on its back. Credit: CDC image library

Vanderbilt medical toxicologists are reporting an increase in patients seen with brown recluse spider bites this summer.

The venomous bites usually heal well if left alone, according to Tennessee Poison Center Medical Director Donna Seger, M.D., but there are so many urban legends about these bites, patients frequently apply many treatments before seeking medical advice.

There are two components to spider bites -- the cutaneous lesion and, more rarely, the systemic symptoms that can occur following the bite. The syndrome known as systemic loxsoscelism consists of brown recluse spider bites accompanied by a fever, rash, muscle pain, with or without hemolysis (breaking down of red blood cells), which can be life threatening, especially in children, Seger said.

"Our recommendations are that all children under 12 with a brown recluse spider bite should have a urine test for the presence of hemoglobin in blood which indicates hemolysis," Seger said.

"If the urine is positive for blood and/or the child has other signs of systemic loxsoscelism (rash, fever), the child should be admitted and observed for hemolysis. If the urine dip is negative, and there are no other signs of systemic loxsoscelism, the child should be seen by a physician the next day."

If adults with a brown recluse spider bite do not have rash, fever or muscle pain there is no need to do a urine test, Seger said.

"As physicians, it is hard for us to do nothing. The cutaneous lesion has classic characteristics, but if physicians are not familiar with this bite, the tendency is to debride and cut out the lesion. This actually slows the healing process and can result in disfigurement that would not occur if the lesion were left alone. Ointments, antibiotics, and dapsone are not recommended. Ice works better than opiates for pain," Seger said.

"We don't know why systemic loxsoscelism occurs in some people with a brown recluse spider bite and not in others but it is life-threatening and does require immediate medical attention. Toxin-induced hemolysis can occur very rapidly and therein lies the life threat, especially in children."

The brown recluse spider, also known as the violin spider, is usually between 6-20 mm. It is typically light to medium brown but can range in color from cream-colored to dark brown or blackish gray. It has six eyes instead of eight and can be identified by the violin-shaped marking on its back.

Source: Vanderbilt University Medical Center

New natural supplement relieves canine arthritis

Portrait old dog

Arthritis pain in dogs can be relieved, with no side effects, by a new product based on medicinal plants and dietary supplements that was developed at the University of Montreal's Faculty of Veterinary Medicine. "While acupuncture and electrical stimulation are two approaches that have been shown to have positive effects on dogs, until now a few studies have investigated a plant-based approach to therapy," explained Professor Éric Troncy, senior author of the study. His findings were published in Research in Veterinary Science.

Troncy and his team worked with 32 dogs (and their owners!) who had been diagnosed with arthritis by X-ray and orthopaedic exam, and who all weighed more than 20 kilograms. By drawing on existing rodent studies and working with Pierre Haddad of the university's Department of Pharmacology, Troncy developed two formulas for his trial. These formulas are not currently commercially available.

The first formula, composed of curcumin, devil's claw, black current, Indian frankincense (Salai), willow bark, pineapple bromelaine and camomile, was developed to treat arthritis-induced inflammation. The second included the same ingredients, plus dietary supplements such as omega 3, chondroitin sulfate and glutamine, and was formulated in the hope that it would promote the regeneration of articulations.

Half the dogs received the first formula for four weeks and then the second formula for another four weeks. The other half, acting as the control, received a placebo. The outcomes were tested using three methods. Firstly, the dogs were filmed as they walked at a consistent speed over a special platform that captures the strength of each paw. Secondly, a special electronic collar recorded the dogs' daily activities. And finally, the owners were asked to provide their own evaluations of their dog's behaviour.

The researchers were able to identify an improvement by the fourth week of the trial. "After the eight week course, on average, the strength of the dogs receiving treatment had improved to the equivalent of a kilo of extra strength per paw, which is moreover. None of these dogs saw their health decline, unlike 35.8% of the dogs who were given the placebo," said Maxim Moreau, who was first author of the study.

The improvements were also reflected in the dogs' daily lives. The collars revealed that the dogs receiving treatment maintained their physical activity, and in fact the group average increased from six hours of daily activity to eight. Meanwhile, the dogs receiving the placebo were progressively less active. "In some cases, we recorded the dogs to ensure that the collar was recording actual physical activity rather than movements such as scratching," Troncy explained.

Nonetheless, the ratings from the owners were more mixed. "This third evaluation was more subjective and the contrast between the test group and the control group less stark," Troncy said. "We suspect that the owner may have forgotten what the animal's behaviour was like before it developed arthritis."

The findings raise the possibility of offering a new form of treatment to human beings. "The model of evaluation that we have used is the best for predicting the efficacy of anti-arthritis treatments. We can therefore consider that clinical trials on humans would have a good chance of having positive outcomes," Troncy said.

About this study: This study was funded in part by a grant from ArthroLab Inc., an ongoing New Opportunities Fund grant (#9483) and a Leader Opportunity Fund grant (#24601) from the Canada Foundation for Innovation for the pain/function equipment, a Discovery Grant (#327158-2008; #441651-2013) from the Natural Sciences and Engineering Research Council of Canada for the bio-analyses and salaries, and by the Osteoarthritis Chair of the University of Montreal Hospital Centre, Université de Montréal. Maxim Moreau received a doctoral scholarship from the Canadian Institutes of Health Research (TGF-53914) -- Strategic Training Initiative in Health Research program (MENTOR) and a doctoral scholarship from the Fonds de recherche du Québec-Santé.

Source: Universite de Montreal