Prevalence Of Chronic Pain In Children And Teenagers Growing

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Main Category: Pain / Anesthetics
Also Included In: Pediatrics / Children's Health
Article Date: 13 Dec 2011 - 9:00 PST

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Persistent or recurring chronic pain in children may result in missing school and withdrawing from social activities. They are also at risk of developing personalized symptoms like anxiety. A group of researchers has established that more children currently suffer from chronic pain and that chronic pain is more prevalent in girls than boys. The findings are the results of the first comprehensive review of chronic pain in children and adolescents in two decades.

Study leader Sara King, PhD, currently Assistant Professor at Mount Saint Vincent University in Halifax, Nova Scotia explained:

"We found that persistent and recurrent chronic pain is overwhelmingly prevalent in children and adolescents, with girls generally experiencing more pain than boys and prevalence rates increasing with age. Findings such as these argue that researchers and clinicians should be aware of the problem and the long-term consequences of chronic pain in children."

To assess the progress made since the first comprehensive review of pain in children and adolescents was published by Goodman and McGrath in PAIN® in 1991, researchers from Dalhousie University and the IWK Health Centre in Halifax, systematically assessed epidemiological studies of pain and classified a set of criteria to assess the quality of the studies that were included in the review. They examined 32 studies, which they categorized according to types of pain, such as headache, back pain, abdominal pain, combined pain, musculoskeletal pain, and general pain.

Although the researchers observed that most types of pain were more prevalent in girls than in boys, the factors for this gender difference are not entirely clear. They noted that pain prevalence rates were likely to increase with age. The impact of pain prevalence for psychosocial variables included low socioeconomic status, low self-esteem, anxiety and depression.

The most commonly studied type of pain in youths was headache, with an estimated rate of 23%, whilst other types of pain, such as back pain, abdominal pain, musculoskeletal pain, and pain combinations, were less often studied. The prevalence rates for other types of pain proved variable due to differences in reporting, yet overall results suggested these types of pain to be highly prevalent in children and youths, with an average prevalence rate ranging from 11% to 38%.

Dr. King commented:

"These rates are of great concern, but what is even more concerning is that research suggests that the prevalence rates of childhood pain have increased over the last several decades."

According to the researchers, many studies did not meet quality criteria, with a great variation in prevalence rates across studies, because of the specific moments the pain was reported. To allow researchers to make direct comparisons in future studies, the authors recommend that new epidemiological studies in this field need to be conducted with clearer operational definitions of pain and better measures of pain intensity, frequency, and duration.

Researchers discovered that several demographic and psychosocial factors were linked to high prevalence rates of specific pain types.

Dr. King declared in a concluding statement:

"By shifting focus to factors associated with chronic and recurrent pain, it may be possible to identify the most salient risk factors, leading to early and intensive interventions for the most at-risk groups."

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Visit our pain / anesthetics section for the latest news on this subject. “The epidemiology of chronic pain in children and adolescents revisited: A systematic review,”
S. King, C.T. Chambers, A. Huguet, R.C. MacNevin, P.J. McGrath, L. Parker, A.J. MacDonald
PAIN®, Volume 152, Issue 12 (December 2011) published by Elsevier. DOI: 10.1016/j.pain.2011.07.016

”The epidemiology of pain in children and adolescents: A review”
Goodman JE, McGrath, PJ.
PAIN®, 1991;46:247-64.

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B Cell Receptor Inhibitor Causes Chronic Lymphocytic Leukemia Remission

Main Category: Lymphoma / Leukemia / Myeloma
Article Date: 13 Dec 2011 - 0:00 PST

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PCI-32765 applies molecularly aimed attack to disease usually treated with chemotherapy combinations

A new, targeted approach to treating chronic lymphocytic leukemia has produced durable remissions in a Phase I/II clinical trial for patients with relapsed or resistant disease, investigators report at the 53rd Annual Meeting of the American Society of Hematology.

"PCI-32765, one of a new class of experimental drugs called B cell receptor inhibitors, has shown impressive potential in this clinical trial for its effectiveness and particularly for its relatively minimal toxicity," said lead investigator Susan O'Brien, M.D., professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center.

According to the National Cancer Institute's Surveillance Epidemiology and End Results database, an estimated 14,570 people will receive a diagnosis of CLL in 2011 and about 4,380 patients will die of the disease.

Six-month progression free survival of 90-92 percent

Of 27 CLL patients treated at a dose of 420 milligrams daily, 70 percent had complete or partial remission at 10.2 months of median follow-up. Six-month progression-free survival was 92 percent. Patients received a median three prior treatments before entering the clinical trial.

At a higher dose of 840 mg, 44 percent of 34 patients achieved complete or partial remission at 6.5 months median follow-up, similar to the response rate of the lower-dose cohort at 6.2 months. Progression free survival at 6 months was 90 percent. Study participants had received a median of five prior treatments.

Overall, five patients (8 percent) of the 61 from both arms had progressive disease and 50 (82 percent) remained on the therapy.

Drug does not suppress blood cell production

CLL presently is treated with combination chemotherapies that can cause myelosuppression - inhibited bone marrow function leading to decreased production of blood cells. The resulting susceptibility to infection can be a problem for patients, O'Brien said.

"PCI-32765 is not myelosuppressive. The main side effect is mild diarrhea that is usually self-limiting," O'Brien said.

Chronic lymphocytic leukemia is caused by overproduction of defective B cell lymphocytes, white blood cells that fight infection by producing antibodies.

PCI-32765 is orally administered and inhibits the Burton's tyrosine kinas (BT) enzyme, which is central to B cell receptor signaling. The drug causes programmed cell death and hinders cell migration and adhesion in malignant B cells.

A Phase III clinical trial is planned. The clinical trial was funded by Pharmacyclics, Inc., the drug's developer.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our lymphoma / leukemia / myeloma section for the latest news on this subject. Study co-investigators with O'Brien are: Jan Burger, M.D., Ph.D., also of MD Anderson's Department of Leukemia; Kristie Blum, M.D., Amy Johnson, Ph.D., Nyla Heerema, Ph.D., and John Byrd, M.D., of The Ohio State University; Richard Furman, M.D., of Weill Cornell Medical College; Steven Coutre, M.D., of Stanford Cancer Center, Stanford University School of Medicine; Jeff Sharman, M.D., of U.S. Oncology; Ian Flinn, M.D., Ph.D., of Sarah Cannon Research Institute, Nashville, TN; Barbara Grant, M.D., Vermont Cancer Center, University of Vermont, and Tasheda Navarro, Eric Holmgren, Ph.D., and Eric Hedrick, M.D., all of Pharmacyclics, Inc.
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Some Patients With Chronic Hepatitis C May Benefit From Boceprevir But Extent Of Added Benefit Still Unclear

Main Category: Liver Disease / Hepatitis
Also Included In: Cancer / Oncology
Article Date: 12 Dec 2011 - 1:00 PST

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The active ingredient boceprevir has been available since the middle of 2011 as a treatment for chronic hepatitis C of genotype 1. In an early benefit assessment pursuant to the "Act on the Reform of the Market for Medicinal Products" (AMNOG), the German Institute for Quality and Efficiency in Health Care (IQWiG) has now examined to establish whether boceprevir offers added benefit in comparison with the previous standard therapy. According to this assessment, the dossier submitted by the pharmaceutical company provides indications of added benefit for patients who have not yet developed liver cirrhosis. However, the extent of this added benefit cannot be classified.

The pharmaceutical company provided no data - or inadequate data - for two other indications - patients with liver cirrhosis and patients for whom prior treatment was totally ineffective (zero response to prior interferon-based therapy) - and therefore added benefit for these patients is not proven.

An addition to previous standard drug therapy

Hepatitis C viruses attack the liver and can trigger inflammation there. If this becomes chronic, cirrhosis can develop and liver function progressively deteriorates. Moreover, the risk of liver cancer (hepatocellular carcinoma, HCC) increases. Boceprevir (trade name Victrelis®, manufacturer MSD Sharp & Dohme) inhibits the reproduction of hepatitis C viruses. Experts assume that if no viruses are detectable in the blood over a sustained period after treatment (sustained virological response, SVR), the risk of secondary disease is reduced.

Boceprevir is administered in addition to the active ingredients peginterferon alfa and ribavirin, which are already on the market. In accordance with the approval status, different patient groups are treated for different periods, as was allowed for in the assessment. The dual combination of peginterferon alfa and ribavirin has been the standard therapy and this was compared with boceprevir given in a triple combination with the former two drugs.

Reduction in secondary diseases: extent cannot be classified

For the two indications of pretreated (treatment-experienced) and non-pretreated (treatment-naive) patients without cirrhosis, data from one approval study each (SPRINT-2 and RESPOND-2) were available. With the available studies, it is not possible to assess directly whether the new active ingredient influences secondary diseases, such as the development of liver cancer. This is partly because the studies have not lasted long enough for these patient-relevant outcomes to be recorded.

With respect to SVR, there was a clear advantage for boceprevir, both for pretreated patients and for non-pretreated patients without liver cirrhosis. However, SVR is not itself a patient-relevant outcome and cannot be equated with "cure", and there are no studies in which SVR is validated as a surrogate outcome in accordance with the usual criteria employed by IQWiG. Nevertheless, the Institute accepts SVR in the context of the assessment as a surrogate for the reduced incidence of liver cancer. This is because it is currently accepted that patients with no detectable hepatitis C virus in the blood are at lower risk of liver cancer. However, it is unclear how many cases of liver cancer can in fact be prevented by boceprevir.

For the outcome "secondary diseases", IQWiG recognizes an "indication" of a benefit for boceprevir. The requirements for a "proof" are not fulfilled, one reason being that the data are only derived from a single study each, with a comparatively small number of patients. Moreover, the scientific data do not permit a conclusive assessment of the number of patients in whom liver cancer is actually prevented. It is therefore unclear whether the added benefit is "minor", "considerable" or "major". For such a case, the corresponding legal ordinance specifies the assessment category of "unquantifiable".

Indication of greater harm for patients without prior treatment

The indication of greater benefit is in contrast to the indication of greater harm, but only in previously untreated patients. In these patients, boceprevir more often led to anaemia, although this was rarely serious. IQWiG classified the extent of this greater harm as "considerable". In contrast, in patients with prior treatment, anaemia was no more frequent than with standard treatment.

Effect on mortality unclear

IQWiG established that the approval studies contained inadequate data on quality of life for patients with or without prior treatment. There were no statistically significant differences in mortality between the treatment groups. It thus remains unclear if and how boceprevir influences mortality.

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Institute for Quality and Efficiency in Health Car. (2011, December 12). "Some Patients With Chronic Hepatitis C May Benefit From Boceprevir But Extent Of Added Benefit Still Unclear." Medical News Today. Retrieved from
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Chronic Pain In Children And Adolescents Becoming More Common

Main Category: Pain / Anesthetics
Also Included In: Pediatrics / Children's Health
Article Date: 10 Dec 2011 - 0:00 PST

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Children who suffer from persistent or recurring chronic pain may miss school, withdraw from social activities, and are at risk of developing internalizing symptoms such as anxiety, in response to their pain. In the first comprehensive review of chronic pain in children and adolescents in 20 years, a group of researchers found that more children now are suffering from chronic pain and that girls suffer more frequently from chronic pain than boys.

"We found that persistent and recurrent chronic pain is overwhelmingly prevalent in children and adolescents, with girls generally experiencing more pain than boys and prevalence rates increasing with age," said lead investigator Sara King, PhD, currently Assistant Professor, Mount Saint Vincent University, Halifax, Nova Scotia. "Findings such as these argue that researchers and clinicians should be aware of the problem and the long-term consequences of chronic pain in children."

Researchers from Dalhousie University and the IWK Health Centre, Halifax, systematically examined epidemiological studies of pain to evaluate progress made since the first comprehensive review of pain in children and adolescents, published by Goodman and McGrath in PAIN® in 1991.1 Additionally, they identified a set of criteria to assess the quality of the studies included in the review. They looked at 32 studies and categorized them according to the type of pain investigated: headache, abdominal pain, back pain, musculoskeletal pain, combined pain, and general pain.

Their findings indicate that most types of pain are more prevalent in girls than in boys, but the factors that influence this gender difference are not entirely clear. Pain prevalence rates tend to increase with age. Psychosocial variables impacting pain prevalence included anxiety, depression, low self-esteem, and low socioeconomic status. Headache was found to be the most common studied pain type in youth, with an estimated prevalence rate of 23%. Other types of pain, ie, abdominal pain, back pain, musculoskeletal pain, and pain combinations, were less frequently studied than headache, and prevalence rates were variable because of differences in reporting. However, the overall results indicated that these pain types are highly prevalent in children and adolescents, with median prevalence rates ranging from 11% to 38%. "These rates are of great concern, but what is even more concerning is that research suggests that the prevalence rates of childhood pain have increased over the last several decades," stated Dr. King.

Researchers also found that many studies did not meet quality criteria and there was great variability in prevalence rates across studies due to time periods over which pain was reported. The authors suggest that future epidemiological studies in this area are in need of better operational definitions of pain and better measures of pain intensity, frequency, and duration. Such quality criteria across studies would allow for direct comparison.

The review identified several demographic and psychosocial factors associated with high prevalence rates of specific pain types. "By shifting focus to factors associated with chronic and recurrent pain, it may be possible to identify the most salient risk factors, leading to early and intensive interventions for the most at-risk groups," concluded Dr. King.

[1] Goodman JE, McGrath, PJ. The epidemiology of pain in children and adolescents: A review. Pain 1991;46:247-64.

Article adapted by Medical News Today from original press release. Source: Elsevier
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How Fruit Flies Can Teach Us About Curing Chronic Pain And Halting Mosquito-Borne Diseases

Main Category: Pain / Anesthetics
Also Included In: Tropical Diseases
Article Date: 08 Dec 2011 - 1:00 PST

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Studies of a protein that fruit flies use to sense heat and chemicals may someday provide solutions to human pain and the control of disease-spreading mosquitoes.

In the current issue of the journal Nature, biologist Paul Garrity of the National Center for Behavioral Genomics at Brandeis University and his team, spearheaded by KyeongJin Kang and Vince Panzano in the Garrity lab, report how fruit flies distinguish the warmth of a summer day from the pungency of wasabi by using TRPA1, a protein whose human relative is critical for contolling pain and inflammation.

In earlier research Garrity's team showed that flies, like humans, sense chemical irritants with TRPA1, indicating an ancient origin for harmful chemical sensing. In 2008, the team demonstrated that this protein serves a second function in flies: sensing warmth.

Gentle warmth and nasty chemicals trigger distinct responses. How can both responses rely on the same sensor? The team has now discovered that there is an easy answer. Insects actually make two forms of TRPA1, one specialized for each task.

What is the significance of this new research?

Such TRPA1 specialization has implications for devising bug sprays and traps to combat the transmission of diseases like malaria, dengue and West Nile virus. "This work on TRPA1 can explain how blood-sucking insects like mosquitoes discriminate noxious chemicals, which repel them, from the warmth of a human, which attracts them," says Garrity. "By activating one kind of TRPA1 you might be able to deter mosquitoes from biting you, while activating the other kind of TRPA1 might lure mosquitoes to a trap."

These findings also have implications for understanding the way that human damage-sensing neurons work, explains Garrity. Since human TRPA1 is a drug target aimed at treating diseases such as asthma, migraines, and chronic pain, Garrity says it's important to understand how TRPA1 proteins operate.

"Fruit flies are easy to work with in the lab and this lets us test hypotheses about how TRPA1 operates quickly and relatively cheaply." Says Garrity. "Fortunately, the function of TRPA1 seems evolutionarily ancient and conserved from flies to mosquitoes to humans, so one can gain insights of general biomedical relevance using flies."

"Untreatable chronic pain and insect-borne diseases are two major human health problems," says Garrity. "When you think about basic research translating into treatments to help people, work in these areas has tremendous potential for easing human misery."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our pain / anesthetics section for the latest news on this subject. The study was funded by the National Science Foundation, National Institute of Mental Health and the National Institute of Neurological Disorders and Stroke.
Brandeis University Please use one of the following formats to cite this article in your essay, paper or report:

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Scientists Identify Strategies To Conquer Lifestyle And Genetic Factors Related To Chronic Diseases

Main Category: Genetics
Also Included In: Allergy;  Immune System / Vaccines
Article Date: 08 Dec 2011 - 2:00 PST

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A dramatic increase in the incidence of chronic inflammatory diseases such as asthma, allergy, and irritable bowel syndrome, has led to concern about how modern lifestyles may trigger physiological defense mechanisms. Now, in the context of a foresight study under the auspices of the European Science Foundation (ESF), a group of scientists has examined the challenges associated with chronic inflammatory diseases, and described 10 key areas with the highest priority for research. Their recommendations are published in a supplement to The Journal of Allergy and Clinical Immunology (JACI), the official journal of the American Academy of Allergy, Asthma & Immunology (AAAAI).

"Many transmissible diseases have been effectively eradicated over the last half century, yet there has been a marked increase in the incidence of chronic inflammatory diseases," says committee chair Harald Renz, MD, of the Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Phillips University, Marburg, Germany. Strategies are urgently needed to determine the causes of these chronic diseases and identify targets for therapy and prevention."

Factors responsible for the development of chronic inflammatory diseases are not easily determined. While epidemiological evidence clearly points to an environmental influence, not all individuals in these environments develop disease. Susceptibility to chronic inflammatory disease has a clear genetic component, but genetics may not be the only determining factor. Prenatal exposures can influence later susceptibility to disease. After birth, factors such as breastfeeding and exposure to microorganisms appear to further influence the likelihood of developing diseases such as asthma and allergy.

Dr. Renz and his colleagues on the Scientific Committee of the ESF Forward Look on Gene-Environment Interaction in Chronic Disease (GENESIS) identified the following 10 key recommendations as having the highest priority for research into chronic inflammatory diseases:

1. Research should distinguish between therapy and prevention.

2. Large prospective cohort studies including deep phenotyping should be made a priority.

3. Research should focus on the question of tolerance.

4. A global (international) approach should be taken to understanding chronic inflammatory disease.

5. Effective interdisciplinary research strategies must be established.

6. New tools and experimental models must be developed.

7. Protocols for data collection, handling, and storage need to be harmonized.

8. Substantial investment must be made in infrastructure, personnel, and development of research tools.

9. Dedicated funding must be provided for interdisciplinary research.

10. Effective public-private partnerships must be developed to ensure free exchange of information.

Furthermore, the committee pointed to a series of key strategic research targets for which significant progress in the management of chronic diseases may be achieved.

Therapy and Prevention. Given the complexity of chronic inflammatory diseases, therapies must be based on deep environmental, clinical and biological phenotyping of patients. Without deep phenotyping, it is impossible to determine whether a potential therapy is clinically ineffective or simply inappropriately targeted. The committee calls for the identification of novel biological markers to enhance patient stratification, and for investments in bioinformatics and systems biology to realize the full potential of omics data.

For prevention, key issues include the selection of appropriate populations and the long-term tolerability of putative long-term protective agents. The results of clinical studies of probiotics as infant food supplements to prevent allergic disease have been mixed. The committee recommends that the term probiotic be employed with caution, and that further research be done to understand the function of gut microbes in health and disease.

Large Cohort Studies. The committee calls for large cohort studies, initiated prior to birth, to fully take into account the impact of how intrinsic and extrinsic factors determine the probability that an individual will be healthy or develop a chronic disease, given the right environmental stimuli. Such studies would analyze biological data including genomic, clinical, and environmental factors, and also psychosocial factors such as stress. It will be important to ensure international collaboration and coverage of populations with different lifestyles and environmental exposures.

Partnerships. The shifting global pattern of chronic disease to developing nations offers an opportunity to identify key factors that confer both risk and protection. The committee recommends that research projects be established in regions with low or developing risk of chronic inflammatory disease, and the establishment of parallel birth cohorts in low- and high-risk regions. Cross-disciplinary partnerships will be essential as well, extending beyond traditional disciplines such as epidemiology and microbiology to mathematics, virology, and ecology. Finally, effective private-public partnerships, with more fluid exchanges of information between academia and industry, will be a key driving force for future research.

Research Tools, Data Generation and Management, and Infrastructure and Personnel. New research strategies that consider the diversity of the microbiome in the choice of experimental models and the potential reproducibility of results will be needed. Because of the complexity introduced by the microbiome, substantial investment will be required to develop the bioinformatics and systems biology approaches required to analyze the datasets generated. An electronic infrastructure to support integrated approaches and open collaboration will be necessary. Funding should be made by panels in which no specific discipline is over-represented to support unbiased approaches. And, a new generation of biological and medical scientists will need to be ready to exploit rapid developments in information technology. They will need to use insights from a range of scientific disciplines as well as fields as diverse as finance and engineering. The committee suggests the creation of international graduate schools to provide specific training in interdisciplinary research.

In the foreword accompanying the supplement, Lars V. Kristiansen, PhD, Science Officer, European Science Foundation, European Medical Research Councils, Strasbourg, France, and colleagues comment, "The socioeconomic costs of chronic diseases are staggering and ever increasing. There is an urgent need to prioritize resources and identify the most efficient scientific and societal initiatives to be adopted. National collaboration within the European region represents the most efficient manner in which strategies for amelioration of chronic inflammatory diseases in the western world may be achieved."

Article adapted by Medical News Today from original press release. Source: Elsevier
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