PARALYZED PATIENTS HAVE WEAKER BONES HIGHER RISK OF FRACTURES THAN EXPECTED

People paralyzed by spinal cord injuries lose mechanical strength in their leg bones faster, and more significantly, than previously believed, putting them at greater risk for fractures from minor stresses, according to a new study by a research team at Worcester Polytechnic Institute (WPI).

The results suggest that physicians need to begin therapies for spinal cord injury patients sooner to maintain bone mass and strength. The data also serve as a warning to physicians treating patients with osteoporosis to think beyond the standard bone density test when assessing risks of hip and other fractures. Details of the study are reported in the paper "Reduction in Proximal Femoral Strength in Patients With Acute Spinal Cord Injury" published by the Journal of Bone and Mineral Research.

"It's not just a question of how much bone mass is lost, but where that loss is occurring," said Karen Troy, PhD, assistant professor of biomedical engineering at WPI and senior author of the paper. "We found that bone loss occurred sooner in mechanically important areas and significantly increased the risk of fracture."

Estimates of the number of Americans living with spinal cord injuries range from 300,000, according to the National Spinal Cord Injury Statistical Center, to 1.2 million in a study funded by the Christopher and Dana Reeve Foundation. Both sources agree that the leading causes of these injuries are auto accidents, workplace accidents, falls, sports injuries, and violent crime.

Healthy bones adapt to the mechanical forces they encounter, with new bone formation and existing bone resorption constantly occurring to meet the body's needs. When bones stop carrying loads, however, they begin to lose mass and weaken. For patients with spinal cord injuries, this dramatic decline in bone strength often causes broken legs or knees from otherwise minor impact or stresses. "Their bones are so fragile, that just the act of rolling over in bed can snap their knee or leg," Troy said.

In the current study, Troy and her co-authors, W. Brent Edwards at the University of Calgary and Thomas Schnitzer at Northwestern University, captured and analyzed data from 13 spinal cord injury patients treated at the Rehabilitation Institute of Chicago. Each patient received two standard scans (a DXA bone mineral density scan and a CT scan) of their leg bones at specified time intervals for nearly four months after the original injury. The scans documented the change in bone mass over time. The team then used sophisticated computer modeling systems to process the scan data and simulate how the amount and distribution of bone loss would affect the ability to sustain mechanical loads and movements.

That analysis showed that patients in the study lost 2 percent of their leg bone mass each month, yet that correlated with a 6.9 percent loss in leg bone strength. "In just 3.5 months, reductions in strength for some patients were on the order of that predicted for lifetime declines owing to aging," the authors wrote.

Starting therapies early to maintain bone mass and strength is important for these patients, Troy noted, not only to prevent injuries but also to keep patients eligible for treatments and technologies now in development. "In ten or fifteen years, with advances in tissue regeneration to repair the spinal cord, and exoskeleton assist devices, many of these people will have the opportunity to get back on their feet, if their bones are strong enough to carry the load," Troy said. "It's very difficult to restore bone mass once it's lost, so the better approach is to prevent the loss in the first place."

Bone loss and the risk of fracture is also a serious concern for the 54 million people in the United States who have low bone density or osteoporosis.1 The three-fold difference observed in bone mechanical strength versus density in the current study should prompt additional review of how physicians assess risk and treat patients with this condition. "Bone mineral density is important, but it doesn't tell the whole story," Troy said.

Do Women Deal With Pain Better Than Men

Today's fascinating article comes from health.com (see link below) and discusses the reasons why women react to to pain differently to men. Women have long claimed that they can suffer pain with more fortitude than men but are there reasons for that and is it true? It's a useful discussion, especially when applied to how the sexes cope with neuropathic pain. If women truly feel pain more intensely, yet deal with it better, are there any lessons to be learned? Is there something in the female physiology that facilitates this?

How Women's Pain Differs from Men's

Women feel pain more intensely—and in higher numbers—than men, but it's not exactly clear why

Women have been saying for years that if men were responsible for giving birth, the human race would have died out long ago because guys couldn't take the pain.

It's a clever dig—because, well, it's impossible to prove. But in fact, lab experiments suggest that women are more—not less—sensitive to pain than men.

"Contrary to popular opinion, it is very clear that women have a lower pain threshold and tolerance than men," says Roger Fillingim, PhD, a pain expert and professor of community dentistry and behavioral science at the University of Florida, in Gainesville. When study volunteers are exposed to an increasingly painful stimulus (such as a heat source) in experiments, Fillingim says, "women say 'stop' sooner."

This may explain in part why chronic pain conditions such as arthritis and migraine are more common among women, in some cases dramatically so. Fibromyalgia—a chronic condition marked by widespread pain, as well as fatigue and other symptoms—affects seven times as many women as men, for instance.

Exactly why women feel pain more intensely—and in higher numbers—than men remains a mystery. It's not simply that women aren't as "tough." Pain is a complex phenomenon, and how a person responds to it involves physical, psychological, and even cultural factors.

"Women experience more pain then men," Fillingim says. "We know a lot of different whys, but we don't have a single answer."

Questions remain, but the female body and mind do appear to process pain differently than a man's. And these differences can affect every aspect of pain, from the physical sensation itself to how women cope with chronic pain and what treatments are likely to be most effective for them.

Different bodies, different pain
Sex hormones may be responsible for much of the difference in how women and men experience pain, experts say.

Estrogen levels, which fluctuate according to the menstrual cycle and also dwindle as a woman enters menopause, have been linked to changes in how a woman feels pain, says Jennifer F. Kelly, PhD, a clinical psychologist at the Atlanta Center for Behavioral Medicine.

The relationship appears to be complicated, however. Some studies have shown that women are more sensitive to pain when their estrogen levels are low (during menstruation, for instance), while others have shown the exact opposite. It's still unclear whether estrogen makes pain better or worse, Fillingim says.

Psychological factors also likely play a role in gender-based pain differences. More so than men, who are apt to focus on the immediate physical sensation of pain, women tend to think about the consequences pain will have on their lives, Kelly says.

"If a man hits his hand, his hand hurts," Kelly says. "But if a woman hits her hand, she focuses on the emotional aspects...and how it is going to impact day-to-day functions. Women tend to experience more pain as a result, possibly because the emotions associated with pain are usually negative."

While this may sound like a cliche straight out of Men Are from Mars, Women Are from Venus, it's backed up by studies that have used brain scans to identify the regions of the brain that respond to pain. When women and men receive the same pain stimulus, women show more activity in the emotional centers of their brains, while in men the cognitive and analytical areas of the brain tend `to light up.

Other health conditions—most notably depression—may magnify the emotional response to pain. Women are more likely to be diagnosed with depression, which is a risk factor for chronic pain conditions, says Kelly, who gave a presentation on gender and pain at a recent meeting of the American Psychological Association in San Diego.

How women cope
Strategies for coping with chronic pain also differ between the sexes. These differences are potentially important, since how a person copes with pain can actually influence how much pain they feel.

For instance, women are more likely than men to turn to friends, family, and other sources of social support to talk through how their pain is affecting them, Fillingim says. That's generally a good thing, but some studies suggest that women are also more likely to exaggerate their chronic pain and the negative consequences it has on their lives.

This excessively pessimistic or melodramatic thinking—"catastrophizing," some pain experts call it—can backfire and make pain worse. It tends to elicit hostility from spouses, family, and friends (rather than support), and it's linked to higher levels of pain and depression.

The roles that women play in their families—as well as in society more broadly—can also shape how they cope with chronic pain, says Carmen R. Green, MD, a professor of anesthesiology and ob-gyn at the University of Michigan, in Ann Arbor. In some cases, expectations for women's behavior and their responsibilities can actually lead them to downplay their pain and try to fight through it—the opposite of catastrophizing. "Women will always take care of their kids, so it appears that they are functioning better because they have no choice," Dr. Green says.

In some ways, women cope with pain more constructively than men do, Dr. Green says. "Women enter the health care arena sooner than men, which may be a positive coping step, and they tend to have a more varied and larger social networks," she says. The latter means they may have more shoulders to lean on when their pain is acting up.

Finding the right pain treatmentDespite the many differences in pain between genders, treatments aren't always tailored to women and men. And women in particular are at risk for having their pain poorly assessed and undertreated, Kelly says. (It probably doesn't help that the majority of pain physicians are men.)Pain medications often have disparate effects—and side effects—in women and men, according to Kelly. "Physicians working with females have to be aware that women have more side effects from medications, and have to work with them differently and find something that can be a benefit with the least amount of side effects across the board," she says.

Doctors prescribe pain medicine based on how the drugs are metabolized by a 150-pound man, Dr. Green adds. "We have to do more clinical trials on women to see if age—and whether they are pre, peri-, or post-menopausal—affects how they respond to medications to treat their pain," she says.

In many cases, non-medical treatments such as cognitive behavior therapy may be especially beneficial for women, Kelly says. This brief, focused therapy addresses coping skills and seeks to change the thought patterns associated with pain (such as catastrophizing) and the impact they have on a person's quality of life.

"We need to teach women to be good advocates for themselves about their pain and how it impacts their life, so that they can see their doctor and say 'This is where it hurts', 'This is what makes it feel better,' 'This is what I can do' and 'This is what I can't do," Kelly says.

http://www.health.com/health/condition-article/0,,20424823_3,00.html

CLUE TO WHY FEMALES LIVE LONGER THAN MALES

A study from the University of Exeter has found that male flies die earlier than their female counterparts when forced to evolve with the pressures of mate competition and juvenile survival. The results could help researchers understand the mechanisms involved in aging.

The research, published in the journal Functional Ecology, used populations of the fly Drosophila simulans that had evolved under different selection regimes. The study shows that mate competition (sexual selection), along with survival (natural selection), is tougher on male aging than it is on females reducing their lifespan by about a third.

Some species, like the flies in this study, age quickly over a number of days while others -- including some trees and whales -- age slowly across centuries.

Professor David Hosken from Biosciences at the University of Exeter said: "We found dramatic differences in the effects of sexual and natural selection on male and female flies. These results could help explain the sex differences in lifespan seen in many species, including humans, and the diverse patterns of aging we observe in nature."

The flies were subjected to elevated or relaxed sexual and natural selection and left to evolve in these conditions. To elevate sexual selection groups of males were housed with single females. A stressful temperature was used to elevate natural selection.

Males court females by singing, dancing and smelling good but their efforts come at considerable cost and this cost is amplified when they also have to cope with stressful temperatures.

The results of the study showed that under relaxed sexual and natural selection, male and female flies had very similar lifespans -- around 35 days. However males that evolved under elevated sexual selection and elevated natural selection had a much shorter lifespan -- just 24 days -- and died seven days earlier than females under the same conditions.

Both sexual selection and natural selection were found to affect lifespan but their effects were greatest on males. The findings show that the sexes can respond differently to the same selection regimes.

Neuropathy Can Affect More Than Your Feet Vid

Today's short video from creativepharmacist.com is addressed towards diabetic neuropathy sufferers but in this case, the information applies to many other neuropathy sufferers and talks mainly about autonomic neuropathy (neuropathy that affects involuntary functions of the body: digestion, sexual performance, breathing etc). It's very short, doesn't tell you much but leads you towards more information on their site. It's very possible that you weren't aware that neuropathy can affect other areas of your body apart from your feet and legs. For more information on this blog, check out 'autonomic neuropathy' in the alphabetical list to the right of the blog, or use the search function to find more articles on the subject.




Sweet Spot January 2013 - Neuropathy

SADNESS LASTS LONGER THAN OTHER EMOTIONS

Why is it that you can feel sad up to 240 times longer than you do feeling ashamed, surprised, irritated or even bored? It's because sadness often goes hand in hand with events of greater impact such as death or accidents. You need more time to mull over and cope with what happened to fully comprehend it, say Philippe Verduyn and Saskia Lavrijsen of the University of Leuven in Belgium. Their research, published in Springer's journal Motivation and Emotion, is the first to provide clear evidence to explain why some emotions last a longer time than others

The Belgian researchers asked 233 high school students to recollect recent emotional episodes and report their duration. The participants also had to answer questions about the strategies they use to appraise and deal with these emotions.

Meaningful differences in duration were indeed found to exist between emotions. Out of a set of 27 emotions, sadness lasted the longest, whereas shame, surprise, fear, disgust, boredom, being touched, irritated or feeling relief were often over in a flash. Interestingly enough, boredom also counts among the shorter emotions experienced. Verduyn and Lavrijsen say that this means that even though time seems to pass slowly when one is bored, an episode of boredom typically doesn't last that long.

The researchers discovered that emotions that last a shorter time are typically elicited by events that have relatively low importance attached to them. On the other hand, long-lasting emotions tend to be caused by events that have strong implications for a person's major concerns. Verduyn says some of these implications may only become apparent over time, which then causes the emotion to be maintained or strengthened. The feeling therefore endures while a person rethinks the events and consequences over and over again.

Duration was found to be a dimension that can differentiate between otherwise very similar emotions. For instance, Verduyn and Lavrijsen found that guilt is an emotion that persists much longer than shame, while anxiety lingers longer than fear.

"Rumination is the central determinant of why some emotions last longer than others. Emotions associated with high levels of rumination will last longest," says Verduyn, explaining the role that such constant and repetitive thinking has on the experience of positive and negative emotions.

"Emotions of shorter duration are typically -- but, of course, not always -- elicited by events of relatively low importance. On the other hand, long-lasting emotions tend to be about something highly important," Lavrijsen explains further.