Finding Menthol Sensory Receptor Could Lead to Better Pain Treatments

The protein in the peripheral nervous system that gives mice the ability to sense cold and menthol has been identified, according to three recent journal articles. Menthol receptor TRPM8, as this protein is known, is found in humans and researchers believe these findings extend to people.

“[The receptor] provides a target for studying acute and chronic pain, as can result from inflammatory or nerve injury, the researchers say, and a potential new target for treating pain.

“’By understanding how sensory receptors work, how thresholds for temperature are determined, we gain insight into how these thresholds change in the setting of injury, such as inflammatory and nerve injury, and how these changes may contribute to chronic pain,’ says senior author David Julius, PhD, chairman and professor of physiology at UCSF.” (from UCSF press release, Detecting Cold, Feeling Pain: Study Reveals Why Menthol Feels Fresh)

Although the article only addresses pain caused by physical injury, it seems that the findings can apply to headache too. Nerves outside the brain, which are called peripheral nerves, become sensitized in both migraine and tension-type headaches. This is the source of allodynia — being sensitive to touch or feeling like your hair hurts.

Central Sensitization Determines Ideal Time for Migraine Treatment is the most reader friendly article that describes the role of peripheral nerves in migraine. I can only find basic information on tension-type headache and peripheral nerves. Do you know of any good resources on the topic?

I know I’m skimming the surface here. Any comments on the study or the role of peripheral and central sensitization in headache and migraine will be greatly appreciated.


Summer Seasonal Affective Disorder

A well-known winter phenomenon, seasonal affective disorder strikes some people in summer. As depression and headache disorders tend to occur together, it’s important to watch out for symptoms. Particularly in summer, when it’s easy to mistake depression symptoms with the sapping properties of heat.

In winter, people with SAD tend to sleep more, have less energy,
gain weight and crave carbohydrate. Summer SAD sufferers usually sleep less, lose weight and have anxiety.

Because summer SAD doesn’t appear to be light-related, as it is in winter, the treatments that are effective for winter SAD don’t work for summer sufferers. Antidepressants and “lifestyle changes” are recommended instead. Examples include swimming in cold water every day, avoiding daylight and heat, and listening to a rain-sounds CD.

The New York Times has another informative article: Seasonal Depression Can Accompany Summer Sun. Mayo Clinic explains SAD’s symptoms, causes and treatments.

Photo by Arnaud Desbordes.

Newsweek on Chronic Pain Research & Treatment

Pain research and treatment are the topics of this week’s Newsweek cover story. The article centers on chronic pain caused by physical injuries in war, but it has gems for anyone with chronic pain. There’s a great illustration of how opioids and nerve blockers affect pain signals in the Pain and its Pathways graphic.

“‘The public understanding of pain has been that it’s a stubbed toe or a broken bone,’ says Will Rowe, executive director of the American Pain Foundation. ‘But that’s just one aspect of it. Now there’s a growing awareness that pain is a disease of its own.’

“This is far more than a semantic change, Rowe adds: it’s ‘tectonic.’ Docs now know that the brain and spinal cord rewire themselves in response to injuries, forming ‘pain pathways’ that can become pathologically overactive years later. They are trying to sever this maladaptive mind-body connection with a host of new drugs and approaches. Some focus on recently discovered chemical receptors in the brain and muscles. Others pack all the punch of narcotics with less of the specter of addiction. . . . New types of electrical stimulators targeting the brain, the spine and the muscles hit the market almost every year. Fentanyl skin patches, first introduced in 1990, have evolved into a patient-controlled, push-button device called IONSYS, available by the end of this year.”

Later in the article:

“Some of the most promising pain treatments of the past decade have turned out to be disappointments. Studies of some radiofrequency therapies show they work no better than placebos. Spinal-fusion surgery, a recent review found, has ‘no acceptable evidence’ to support it. And if a treatment does work, says Edward Covington, a pain specialist at the Cleveland Clinic, ‘for most people, the effect is temporary.’ There is no cure for chronic pain, period.

“There’s not even any ‘single drug or technology alone’ that can treat all the types of pain, says Eugene Viscusi, director of acute-pain management at Thomas Jefferson University Hospital in Philadelphia. Most people need two or three therapies in combination. Scientists’ new understanding of pain’s broad effects on many levels of the nervous system explains why: a multipart syndrome requires multipart therapy. Viscusi notes that patients under anesthesia still have elevated levels of the pain enzyme Cox-2 in their spinal fluid following surgery. They may not feel pain, but some parts of their brains still think they’re in it. For any treatment to work long term, it will have to address not just the immediate sensation of pain but the other, subtler aspects—and there are surely some of those that scientists don’t know about yet.”

Looking for Men With Headache Disorders

As a woman with migraine and chronic daily headache, I tend to write about women with migraine or chronic daily headache. But there still are men with these and other headache disorders. (For example, although three times as many women as men have migraine, more men have cluster headaches.)

Reader Andy asked me for resources for men with headache disorders. I haven’t been able to find much. Andy was kind enough to share his experience:

“I woke up with a headache on January 22, 2005 and it’s been there ever since. I also determined through my own research that it is New Daily Persistent Headache – it has the symptoms of chronic daily headache without the traditional migraine elements. Most days it’s pretty mild, allowing me to live my life fairly normally as long as I’m distracted by my job, family, baseball game, etc. But it never goes away. It’s always there, and it’s really devastating to think I’ll be spending the next 50 years of my life in pain. 50 years! See how terrible that sounds? I just came across this blog for the first time and it’s somewhat comforting to know there are other people out there who can relate to that. Depressing, yet comforting.”

A surprising number of headache blogs are written by men. These are the ones I know of; please let me know of any others.

I know there are plenty of men reading this post. How do you cope with your headache disorder? What are your favorite sources for learning about men and headache?

Marijuana a “Wonder Drug”

“If marijuana were a new discovery rather than a well-known substance
carrying cultural and political baggage, it would be hailed as a wonder
drug,” according to Harvard Medical School emeritus professor of psychiatry Lester Grinspoon. Marijuana as Wonder Drug, Grinspoon’s Boston Globe opinion piece, is an interesting take on the controversial topic.

You can learn more on Marijuana Uses, Grinspoon’s website. RxMarijuana has links to articles he has written for the general public. And you’ll find many more by Googling Lester Grinspoon.

Free Book: Memoir About Living With Chronic Illness

Update, 9:37 p.m. The book is spoken for. Thanks for all the responses.

Blindsided: Lifting a Life Above Illness, by Richard M. Cohen

Here’s the publisher’s description:

“Richard Cohen, a veteran writer, producer and distinguished
journalist, has lived with multiple sclerosis for over 25 years.
Recently diagnosed again with colon cancer, Cohen describes his
lifelong struggle with multiple sclerosis, his first bout with colon
cancer, a loving marriage to Meredith Viera, the effect of illness on
raising children, and the nature of denial and resilience, all told
with grace, humour, and lyrical prose.

“Cohen chronicles and celebrates a life brimming over with
accomplishment, adversity and personal endeavour and his story has
struck a chord with readers nation-wide. He has been interviewed by
Barbara Walters for a nearly hour-long segment that ran on 20/20, he
also appeared on wife Viera’s program, The View and is scheduled for
Charlie Rose, Larry King Live, Good Morning America, and the Paula Zahn
Show, among others. Blindsided also received outstanding print
attention and People magazine has run a first serial piece.

“Autobiographical at its roots, reportorial and expansive, Blindsided
builds on Cohen’s story as a task aimed at emotional well-being, if not
survival, pursued in sober tones that explore coping to its most
redemptive and complex levels. Despite his extreme circumstances,
Cohen’s is a common struggle, recognisable as an integral part of
humanity, and one which he explores with varying amounts of diligence,
respect, personal revelation and humour.”

Want it? I’ll send it to the first person who e-mails me with their address.

Working With Chronic Illness

Written by two working women with chronic illness, Keep Working, Girlfriend is a blog to help other women (and men) continue working and enjoying the benefits of work. The driving force behind the blog is that “it’s critical to your health — mental, physical, emotional and financial — to keep working.”

At first I didn’t agree. My last job was horrendous, partly because of the work environment and partly because my chronic daily headache was so bad. Far from improving my emotional and physical health, I despaired my lack of productivity and was constantly exhausted. My headaches and migraines were far worse than they had ever been.

Now that I’ve been blogging for nearly two years, Keep Working, Girlfriend resonates with me. It’s hard to believe I didn’t lose my mind during the 18 months I didn’t work. (Or perhaps I did — that period corresponds with one of my worst depressions.)

I have days that I’m not up to any sort of work and I still can’t write as much as I’d like to. Nonetheless, when I can work and have a specific, productive task with a deadline, I’m so much happier and more productive in other areas of my life.

However, working with chronic illness is not always the most healthful approach. If the job is too emotionally or physically draining, it can cause more harm than good. Work itself is not the key: the work has to be enjoyable.

“Work” doesn’t have to be defined as earning a wage. If you’re not able to work a paying job, get creative about what work you can do. Maybe it’s gardening, knitting or writing in a journal. Even taking a shower can be a big accomplishment. Anything that’s satisfying to you and has a clear result.

And lack of stamina isn’t a good excuse! As I’ve learned, committing to just 10 minutes of a rewarding activity is better than not doing it at all. So you only weed two square feet of your garden; it’s more than you would have done otherwise.

I write this on a morning where I struggled to get out of bed, so I hope I don’t sound preachy. I just know it works for me. I’m also aware that if my only aspiration is to lie around and read all day, I need to actively decide whether I’m showing signs of depression or truly feel too horrendous to move.

Are you able to work? Is it rewarding for you? If you don’t work, how do you motivate yourself to work?