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

Novel microneedle patch for faster, effective delivery of painkiller, collagen

Dr Kang Lifeng of the Department of Pharmacy at NUS holding a microneedle patch in his left hand, and a photomask in his right hand. Credit: National University of Singapore

Individuals who are squeamish about injections or are looking for a way to let collagen penetrate deeper into the skin may soon have a solution that is faster, more effective and painless. The key lies in a small adhesive patch topped with minuscule needles that is pioneered by researchers from the National University of Singapore (NUS).

The research team, led by Dr Kang Lifeng of the Department of Pharmacy at the NUS Faculty of Science, has successfully developed a simple technique to encapsulate lidocaine, a common painkiller, or collagen in the tiny needles attached to an adhesive patch. When applied to the skin, the microneedles deliver the drug or collagen rapidly into the skin without any discomfort to the user.

This innovation could be used clinically to administer painkiller non-invasively to patients, or in home care settings for patients suffering from conditions such as diabetes and cancer. In addition, the novel transdermal delivery system could also be used for cosmetic and skincare purposes to deliver collagen to inner skin layers.

Non-invasive delivery of drugs for effective pain relief

Faster delivery of painkillers is key to effective management of acute and chronic pain conditions. Currently, such drugs are mainly administered through invasive injections, or through the use of conventional transdermal patches, which may have limited efficiency due to variability of drug absorption among individuals.

To address the clinical gap, Dr Kang, together with Dr Jaspreet Singh Kochhar, who had recently graduated from NUS with a doctorate degree in Pharmacy, and their team members, used a photolithography based process to fabricate a novel transdermal patch with polymeric microneedles. The tiny needles are encapsulated with lidocaine, a common painkiller known for its pain-relief property.

Laboratory experiments showed that the novel microneedles patch can deliver lidocaine within five minutes of application while a commercial lidocaine patch takes 45 minutes for the drug to penetrate into the skin. The shorter time for drug delivery is made possible as the miniature needles on the patch create micrometre-sized porous channels in the skin to deliver the drug rapidly. As the needle shafts are about 600 micro-meters in length, they do not cause any perceivable pain on the skin.

The patch also comprises a reservoir system to act as channels for drugs to be encapsulated in backing layers, circumventing the premature closure of miniaturised pores created by the microneedles. This facilitates continued drug permeation. In addition, the size of patch could be easily adjusted to encapsulate different drug dosages.

By delivering painkillers faster into the body through the skin, patients could potentially experience faster pain relief. In addition, enabling a larger amount of lidocaine to permeate through the skin could potentially reduce the time needed to apply the patch and this reduces the likelihood of patients developing skin irritation.

This novel technique was first reported in the scientific journal Molecular Pharmaceutics.

Enabling deeper penetration of collagen into the skin

To expand their research on potential applications of the microneedles patch, the NUS team 
conducted a study to explore its effectiveness in delivering collagen into skin.

The researchers encapsulated collagen in the microneedles and tested the transdermal delivery of collagen using the novel technique. They found that collagen can be delivered up to the dermis layer of the skin, while current skincare products can only deliver to the outermost layer of skin.

The findings of this study were first published earlier this year in the scientific journal Pharmaceutical Research.

Further research to expand application of novel microneedles patch

As their novel technique for drug delivery is non-invasive and easy to use, the NUS team envisioned that the microneedles patch has great potential for applications in clinical and home care settings for the management of perioperative pain and chronic pain in patients suffering from conditions like diabetes and cancer.

The innovative patch could also have pediatric applications. Dr Kang explained, "One prospective application is during vaccination for babies. The patch can be applied on the baby's arm five minutes before the jab, for the painkiller to set in. In this way, vaccination can potentially be painless for babies."

The research team intends to conduct clinical testing of the painkiller patch to further ascertain its effectiveness for clinical applications. They will also be conducting clinical studies to examine the efficacy of delivering collagen for cosmetic and skincare purposes.
Recognizing that their novel transdermal delivery system is easy to fabricate and commercially scalable, the research team is also keen to work with industry partners to commercialize their work.

Source: National University of Singapore

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