50 Million American Adults Have Significant Chronic or Severe Pain

Newswise, August 25, 2015– Nearly 50 million American adults have significant chronic pain or severe pain, according to a new study prepared by National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH), which appears this month in The Journal of Pain, http://www.jpain.org, published by the American Pain Society, http://www.americanpainsociety.org.

Based on data from the 2012 National Health Interview Survey (NHIS), the study estimates that within a previous three-month period, 25 million U.S. adults had daily chronic pain, and 23 million more reported severe pain. Those with serious pain need and use more health care services and suffer greater disability then persons with less severe pain.

The annual NHIS study is conducted by the U.S. Centers for Disease Control and Prevention (CDC) and surveys tens of thousands of Americans about their overall health and illnesses. 

The 2012 NHIS studied asked participants about the frequency and intensity of pain experienced in the last 3 months.

The findings also showed that half of individuals with the most severe pain still rated their overall health as good or better, and there were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, but Asians less likely. Also, the study showed the impact of gender on pain is influenced by race and ethnicity.

In an NIH news release, Richard L. Nahin, Ph.D., M.P.H., lead epidemiologist for NCCIH and author of the analysis said: “This report begins to answer calls for better national data on the nature and extent of the pain problem. The experience of pain is subjective. 

It’s not surprising then that the data show varied responses to pain even in those with similar levels of pain. Continuing analyses of these data may help identify subpopulations that would benefit from additional pain treatment options.”

Publication of the NIH study follows the recent “Pain Research Agenda for the 21st Century,” published in December in The Journal of Pain, in which The American Pain Society identifies promising but underfunded approaches to develop new treatments and to help make currently used pain medications safer and more effective. 

However, APS believes breakthrough new treatments will not become available unless more resources are devoted to pain research. Its Pain Research Agenda states: “The most direct path to achieving dramatic advances in pain treatment is through substantially increased investment in pain research and education, which would enable the pursuit of an aggressive translational pain-research agenda.”

About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering. APS is the professional home for investigators involved in all aspects of pain research including basic, translational, clinical and health services research to obtain the support and inspiration they need to flourish professionally. APS strongly advocates expansion of high quality pain research to help advance science to achieve effective and responsible pain relief. For more information on APS, visit www.americanpainsociety.org.

Saliva Test for Stress Hormone Levels May Identify Healthy Older People with Thinking Problems

Newswise, August 25, 2015— MINNEAPOLIS – Testing the saliva of healthy older people for the level of the stress hormone cortisol may help identify individuals who should be screened for problems with thinking skills, according to a study published in the August 19, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.

The study found that people with higher levels of cortisol in the evening were more likely to have a smaller total brain volume and to perform worse on tests of thinking and memory skills.

“Studies have shown that depression increases the risk for dementia, but we don’t know much about how this relationship occurs,” said study author Lenore J. Launer, PhD, of the National Institute on Aging in Bethesda, Md., and a member of the American Academy of Neurology. 

“High levels of the stress hormone cortisol have been found in people with depression, and the theory is that cortisol has a toxic effect on the hippocampus area of the brain, which plays an important role in memory.”

The study involved 4,244 people with an average age of 76 who did not have dementia. 

Participants had a brain scan to look at brain volume and took tests of their thinking and memory skills. Saliva samples were taken from the participants once in the morning and in the evening to determine cortisol levels. Participants were divided into three groups based on cortisol levels of high, medium and low.

People with the highest level of cortisol were more likely to have a smaller overall brain volume than those with lower levels of cortisol, with a difference of 16 milliliters between the two groups. Those with the highest level of cortisol also performed worse on the memory and thinking tests than those with low levels of the hormone.

“Since this study just looked at a snapshot in time, we don’t know which came first: the high levels of cortisol or the loss of brain volume,” Launer said. “It’s possible that the loss of brain volume that can occur with aging leads to a lesser ability of the brain to stop the effects of cortisol, which in turn leads to further loss of brain cells. Understanding these relationships may help us develop strategies to reduce the effects of cortisol on the brain and thinking skills.”

Launer noted that a limitation of the study was that cortisol was tested only during one day, but said that the large size of the study may balance out that limitation.

The study was supported by the National Institutes of Health, National Institute on Aging, Icelandic Heart Association and Icelandic Parliament.

To learn more about brain health, please visit www.aan.com/patients.

The American Academy of Neurology, an association of more than 28,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, brain injury, Parkinson’s disease and epilepsy.

Research Links Psoriasis, Depression

August 25, 2015--Study finds psoriasis patients have increased depression risk

OVERVIEW
Psoriasis is a common skin condition that affects millions of Americans — and it doesn’t just affect their skin. This disease can have a significant impact on quality of life. New research, presented at the American Academy of Dermatology’s 2015 Summer Academy Meeting in New York, indicates that psoriasis patients may have an increased risk of depression.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT
Information provided by board-certified dermatologist Roger S. Ho, MD, MPH, FAAD, assistant professor of dermatology, The Ronald O. Perelman Department of Dermatology, NYU School of Medicine/Langone Medical Center, New York.

WHAT IS PSORIASIS?
Psoriasis is a chronic inflammatory disease that typically involves the skin and joints. The majority of people diagnosed with the condition have plaque psoriasis, characterized by red, raised patches of skin covered with silvery-white scales. These raised patches, also known as plaques, usually appear on the scalp, elbows, knees, lower back, hands and feet.

Psoriasis is associated with a number of other medical conditions, including diabetes, cardiovascular disease and depression. Dr. Ho has seen the latter condition firsthand in his patients, starting with one who had severe psoriasis and a clear case of depression. “After treating that patient,” he says, “the more I looked, the more I saw depression symptoms in my other patients with psoriasis.”

RESEARCH
Using data from the National Health and Nutrition Examination Survey, Dr. Ho and his colleagues studied cases of psoriasis and depression in a pool of 12,382 adult patients. About 16.5 percent of the psoriasis patients studied met the criteria for major depression, and the odds of having major depression were doubled among psoriasis patients. 

The association between the two conditions remained significant even when researchers adjusted for other risk factors, including age, gender, race, body mass index, physical activity, history of alcohol use and smoking, and history of other conditions like myocardial infarction, stroke and diabetes mellitus.

Dr. Ho believes the connection between psoriasis and depression may be linked to the public’s stigmatization of psoriasis. The condition is highly visible on the skin, especially in the summer months when more skin is exposed, he says, and those who are unfamiliar with the disease may react unfavorably to people who have it. 

“The public should know that psoriasis is not contagious, so there is no need to act differently around psoriasis patients than you would around anyone else,” Dr. Ho says.

Dr. Ho initially expected that patients’ likelihood of depression would be linked to the severity of their psoriasis, but his research indicated that this is not the case. “It seems that it really depends on the patients’ view of themselves, rather than the extent of their psoriasis,” he says.

IMPLICATIONS
Although Dr. Ho’s research indicates an association between psoriasis and depression, it does not prove that one causes the other. In order to learn more about the connection between these two conditions, he says, researchers will need to further investigate the nature of that connection and the science behind it. 

“There may be some biologic or genetic factors in play that we are not aware of yet,” he says.

In the meantime, Dr. Ho says psoriasis patients should be aware of their depression risk and consult a doctor immediately if they experience any depression symptoms. 

He also encourages psoriasis patients to follow the treatment plan prescribed by their dermatologist, as improving their psoriasis symptoms may help alleviate their depression symptoms or prevent the future development of depression. 

The family and friends of psoriasis patients also should be aware of the condition’s connection with depression, Dr. Ho says, as they can help recognize depression symptoms and encourage proper treatment.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE
“Psoriasis has far-reaching implications for patients’ physical and mental health, and that can include an increased risk of depression,” Dr. Ho says. “I encourage all psoriasis patients to see a board-certified dermatologist for treatment, which may help improve their quality of life.”

ACKNOWLEDGMENTS
Dr. Ho would like to acknowledge Brandon Cohen and Kathryn J. Martires, MD, for their contributions to this research.

MORE INFORMATION
Dermatology A to Z: Psoriasis

Physician Support Key to Successful Weight Loss, Study Shows

Findings affirm value of physician involvement in changing unhealthy behavior

Newswise, August 24, 2015 — A review of survey data from more than 300 obese people who participated in a federally funded weight loss clinical trial found that although the overall weight loss rates were modest, those who rated their primary care doctor’s support as particularly helpful lost about twice as many pounds as those who didn’t.

In a report on the study by Johns Hopkins researchers, published in the Aug. 21 issue of Patient Education and Counseling, the researchers say the findings could inform the development of weight loss programs that give primary care physicians a starring role.

Researchers have long known that high-quality patient-doctor relationships marked by empathy, good communication, collaboration and trust are linked to better adherence to medication schedules, appointment keeping and other good outcomes, says Wendy L. Bennett, M.D., M.P.H., assistant professor of medicine at the Johns Hopkins University School of Medicine and a primary care physician at Johns Hopkins Bayview Medical Center. 

Previous studies also have shown, she says, that obese patients are more likely to report poor physician-patient relationships, with evidence of decreased respect and weight bias from providers.

To see whether and what aspects of those relationships might influence weight loss efforts, Bennett and her colleagues reviewed information gathered by Johns Hopkins’ Practice-based Opportunities for Weight Reduction (POWER) trial, a two-year, randomized, controlled study funded by the federal government. 

During the trial, some obese patients worked to lose weight with the aid of health coaches while their efforts were supervised by their primary care physicians.

At the end of the trial, patients filled out surveys that asked, in part, about their relationships with their primary care physician, including questions about how often their providers explained things clearly, listened carefully and showed respect, as well as how helpful their physicians’ involvement was in the trial. 

Of the 347 patients who filled out surveys, about 63 percent were female, about 40 percent were African-American and all were obese, with body mass indices of 36.3 on average. 

Each participant also had one of three cardiovascular disease risk factors: high blood pressure, high cholesterol or diabetes.

Results of a review showed that nearly all of the 347 patient surveys reviewed for the Johns Hopkins study reported high-quality relationships with their physicians, with the overall relationship showing little effect on weight loss. 

However, those patients who gave their physicians the highest ratings on “helpfulness” during the trial lost an average of 11 pounds, compared to just over 5 pounds for those who gave their physicians the lowest “helpfulness” ratings.

Current National Institutes of Health statistics suggest that more than one-third of adults in the United States are obese. 

Though Medicare and private insurance reimbursements are low or nonexistent for physician-guided weight loss interventions, Bennett says, the findings could spur new reimbursement models that provide for physician involvement and enable more team-based care models.

“This trial supports other evidence that providers are very important in their patients’ weight loss efforts,” Bennett says. Many current weight loss programs are commercially run, she adds, and patients often join these programs without their physician’s knowledge.

“Incorporating physicians into future programs might lead patients to more successful weight loss,” she says.

Other Johns Hopkins researchers who participated in this study include Nae-Yuh Wang, Ph.D.; Kimberly A. Gudzune, M.D., M.P.H.; Arlene T. Dalcin, R.D.; Sara N. Bleich, Ph.D.; Lawrence J. Appel, M.D., M.P.H.; and Jeanne M. Clark, M.D., M.P.H.

This work was supported with a grant from the Johns Hopkins University Osler Center for Clinical Excellence at Johns Hopkins. POWER at Johns Hopkins was supported by a grant from the National Heart, Lung, and Blood Institute 

Under grant number 5U01HL087085-05. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute under grant number 5K23HL098476–02. Nae-Yuh Wang is also supported by grants from the National Center for Advancing Translational Sciences under grant number UL1 TR000424 and the National Institute of Diabetes and Digestive and Kidney Diseases under grant number P30DK079637.

Other relevant disclosures: 

The original trial involved a collaboration with Healthways Inc., a disease management company. Healthways provided coaching effort for the transtelephonic intervention and developed the website used in the intervention. 

Healthways provided some research funding to supplement National Institutes of Health support. Under an institutional consulting agreement with Healthways, The Johns Hopkins University received fees for advisory services to Healthways during the POWER trial. Faculty members who participated in the consulting services received a portion of the university fees.

Fewer Skin Moles May Mean More Aggressive Cancer

August 24, 2015--Dermatologist reminds all patients to be aware of their skin cancer risk

OVERVIEW
People with more than 50 moles have an increased risk of developing melanoma, the deadliest form of skin cancer, but those with fewer than 50 moles should still be alert for this disease. In fact, according to new research presented at the American Academy of Dermatology’s 2015 Summer Academy Meeting in New York, those with fewer moles may be diagnosed with more aggressive melanoma than those with many moles.

AMERICAN ACADEMY OF DERMATOLOGY EXPERT
Information provided by board-certified dermatologist Caroline C. Kim, MD, FAAD, director, pigmented lesion clinic, and associate director, cutaneous oncology program, Beth Israel Deaconess Medical Center Department of Dermatology, Harvard Medical School, Boston.

RESEARCH
People with more than 50 moles may be more aware of their skin cancer risk and more likely to visit the dermatologist for screenings, Dr. Kim says. In treating advanced-stage melanoma cases, however, she observed that patients with fewer moles tended to have more aggressive melanoma than those with many moles.

To investigate the differences in melanoma between these two groups, Dr. Kim and her colleagues reviewed the charts of 281 melanoma patients who visited BIDMC in 2013 and 2014. Eighty-nine of these patients had more than 50 moles, while the remaining 192 had fewer than 50 moles.

As Dr. Kim suspected, patients with fewer moles had thicker, more aggressive melanoma than those with many moles. 

The tendency toward thinner, less aggressive melanoma was observed in patients with both a high number of moles and atypical moles, another melanoma risk factor. 

Additionally, those with more than 50 moles were more likely to be diagnosed with melanoma at a younger age than those with fewer moles.

IMPLICATIONS
Dr. Kim says the results of her research could be attributable to several factors. Health care providers may readily identify patients with more than 50 moles as being at risk for melanoma and educate those patients regarding that risk. 

As a result, patients with many moles may be more likely to visit a dermatologist for regular skin exams, allowing for their melanoma to be detected at an earlier stage, when it is thinner and less aggressive.

Additionally, there are biologic differences between patients with many moles and those with few moles, Dr. Kim says, and these differences may be responsible for the variations in melanoma between the two groups. 

“We already know that melanomas are not all the same genetically,” she says. 

“It’s possible that there are different pathways that drive melanoma in these two patient groups, resulting in different degrees of aggressiveness. If patients with fewer moles are more prone to aggressive melanoma, then we need to make sure that they are also being educated and screened, in addition to patients with many moles.”

Dr. Kim says additional large-scale studies will be necessary to confirm the results of her research. Further investigation into the biology of melanoma in these two patient groups will be important, she says, and research on the benefits of population-wide skin cancer screenings may indicate a need for expanded skin cancer detection efforts.

SKIN CANCER DETECTION
Although certain groups have an increased melanoma risk, skin cancer can strike anyone. “It’s important to educate yourself about skin cancer, no matter how many moles you have,” Dr. Kim says. “All skin cancers, including melanoma, are most treatable when they’re detected early, so it’s important to be aware of warning signs on your skin.” 

The Academy recommends conducting regular self-exams to check the skin for suspicious spots, including any moles that exhibit any of the ABCDEs of melanoma:
• Asymmetry: One half of the mole is unlike the other.
• Border: The mole’s border is irregular, scalloped or poorly defined
• Color: The color of the mole varies from one area to another.
• Diameter: The mole’s diameter is larger than 6 mm (the size of a pencil eraser).
• Evolving: The mole’s size, shape or color changes over time.

In addition to the ABCDEs, it’s important to keep an eye out for any spots on your skin that appear different from the others, or anything changing, itching or bleeding. “Watch for ‘ugly duckling’ skin lesions that look out of place, whether they are dark-colored, or pink or skin-colored,” Dr. Kim says. 

“Any unusual or changing lesion should be examined by a board-certified dermatologist.” 

AMERICAN ACADEMY OF DERMATOLOGY EXPERT ADVICE
“This research reminds us that everyone needs to be alert for melanoma, whether they have many moles or just a few,” Dr. Kim says. “Make sure you know how to examine yourself for signs of skin cancer, and bring any suspicious spots to a board-certified dermatologist’s attention.”

ACKNOWLEDGMENTS
Dr. Kim would like to acknowledge Sally Tan, Lauren Strazzulla, Xiaoxue Li, PhD, and Sandra J. Lee, ScD, for their contributions to this research.

Vitamin D Supplements Could Help Reduce Falls in Homebound Elderly

Newswise — WINSTON-SALEM, N.C. – Aug. 18, 2015 – Every year falls affect approximately one in three older adults living at home, with approximately one in 10 falls resulting in serious injury. Even if an injury does not occur, the fear of falling can lead to reduced activity and a loss of independence.

Research has shown that vitamin D plays a key role in maintaining muscle integrity and strength and some studies suggest vitamin D may reduce the risk of falls.

Homebound elderly, a generally vulnerable population due to poor dietary intake and nutrition-related health conditions as well as decreased exposure to sunlight, are at increased risk for low vitamin D levels, possibly leading to more falls.

Researchers at Wake Forest Baptist Medical Center set out to evaluate the feasibility of delivering a vitamin D supplement through a Meals-on-Wheels (MOW) program to improve the clients’ vitamin D levels and reduce falls.

The study is published in the early online edition (8/16/2015) of the Journal of the American Geriatrics Society.

“Falls in homebound older people often lead to disability and placement in a nursing home,” said Denise Houston, Ph.D., R.D., associate professor of gerontology and geriatric medicine at Wake Forest Baptist and lead author of the study.

“One or our aging center’s goals is to help people maintain their independence and live safely at home for as long as possible.”

Participants in the Meals-on-Wheels program in Forsyth County, North Carolina, were recruited to take part in a five-month, single-blind randomized trial.

Sixty-eight study participants received either a monthly vitamin D supplement of 100,000 international units or placebo delivered with their MOW meal.

The study included the participants’ history of falls and their fear of falling, blood tests at the beginning and at end of the trial to measure 25-hydroxyvitamin D (biomarker for vitamin D in blood), and a monthly diary recording falls during the trial period.

At the beginning of this pilot study, the research team found that more than half of the participants had insufficient concentrations of vitamin D in the blood (less than 20 ng/ml), while less than a quarter had concentrations in the optimal range (30 ng/ml or more).

The study showed that the monthly vitamin D supplement was effective in increasing the concentrations of vitamin D in the blood from insufficient to sufficient levels in all but one of the 34 people who received it, and to optimal levels in all but five people. In addition, people in the vitamin D group reported approximately half the falls of those in the control group.

“Although these initial findings are encouraging, we need to confirm the results in a larger trial,” Houston said.

The Wake Forest Baptist team currently is conducting a clinical trial to try to determine how vitamin D affects risk factors for falls such as balance and muscle strength and power.

Funding for the study was provided by the Wake Forest Translational Science Institute and Center for Integrative Medicine and the Claude Pepper Older Americans Independence Center of Wake Forest Baptist.

Co-authors are Janet Tooze, Ph.D., Jamehl Demons, M.D., Brooke Davis, M.S., Rachel Shertzer-Skinner, M.A., Stephen Kritchevsky, Ph.D., and Jeff Williamson, M.D., of Wake Forest Baptist; and Linda Kearsley, B.S., Senior Services Inc., Winston-Salem.

Living Donors and Recipients Want More Information About Each Others’ Health Before Transplantation

Study’s findings challenge current policies on information disclosure

Highlights

• Most donors and recipients support swapping health information before kidney transplantation, but there was low interest in sharing social information.
• Both donors and recipients wanted the transplant team involved in information disclosure.
• Most donors and recipients did not think the recipient had a right to know why a donor was excluded from donating.

Approximately 6,000 living donor kidney transplants are performed annually in the United States.

Newswise — Washington, DC (August 17, 2015) — Both donors and recipients want more information about each others’ health before participating in transplant surgeries, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings challenge current practices and policies on information disclosure for prospective living kidney donors and their intended recipients.

Patients in need of a transplant may want certain information about a potential living donor before accepting his or her organ. 

Likewise, a potential donor may want information about an intended recipient before deciding whether to offer the organ. It is mandatory to disclose to a candidate if the donor is at increased risk for hepatitis or HIV, but national and international living donor guidelines either do not address or are vague about what other information can be shared between prospective living donors and transplant candidates, as well as when to make such disclosures and who should make them.

To determine if the current policies about sharing of information in living kidney transplantation meets the needs of donors and recipients, Lainie Friedman Ross, MD, PhD (University of Chicago) and her colleagues surveyed 236 individuals, 160 of whom identified as potential or actual donors and 76 of whom identified as candidate or actual recipients.

Among the major findings:

• Overall, 79% of respondents supported providing donors with recipients’ general health information that would affect post-transplant health, and 88% supported providing recipients with donors’ general health information. Such information might include individuals’ status related to smoking, heart health, and kidney function.
• There was little interest in sharing social information such as criminal record, sexual orientation, employment status, or religion.
• The closer the donor-recipient relationship, the more information donors and recipients were willing to share.
• Both donors and recipients wanted the transplant team involved in information disclosure.
• More than three-quarters of both donors and recipients did not think the recipient had a right to know why a donor was excluded from donating.

“Our finding that both donors and recipients support greater sharing of health and health-behavior information challenges the current approach to disclosure in organ transplantation. It is also clear that they want the transplant teams involved in these discussions,” said Dr. Ross. 

“The current model of health care decision-making and information disclosure assumes an isolated autonomous individual who makes private health care decisions with his or her own physician, but this fails to capture the fact that donor and recipient outcomes are interdependent. A re-evaluation of current practices and policies should be considered.”

Study co-authors include Leslie Mataya, Jacqueline Meadow, BA, J. Richard Thistlethwaite, Jr, MD, PhD, Didier Mandelbrot, MD, and James Rodrigue, PhD.

Disclosures: The authors reported no financial disclosures.

The article, entitled “Disclosing Health and Health Behavior Information Between Living Donors and their Recipients,” will appear online at http://cjasn.asnjournals.org/ on August 13, 2015.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult your doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN. Call 911 or your doctor for all medical emergencies.

Founded in 1966, and with more than 15,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.