Blocking a stress protein may treat chronic pain

With more than 100 million Americans living with chronic pain, there is a significant need to uncover new treatments for the condition. Now, researchers suggest that blocking a protein that regulates stress could pave the way for such treatments.

Lead study author Dr. Maria Maiarù, of the Department of Cell & Development Biology at University College London (UCL) in the UK, and colleagues publish their findings in the journal Science Translational Medicine. According to the National Institutes of Health (NIH), chronic pain is described as pain that persists for at least 12 weeks, often lasting for months, and in some cases, years.

An NIH survey found that low back pain was the most common form of chronic pain experienced by Americans, followed by headache or migraine, neck pain and facial ache.

Previous studies have suggested that stress may lead to or exacerbate chronic pain, and some research has indicated that people with certain variations of a gene called FKBP5 experience greater physical pain after trauma than those without such variations.

What is more, specific FKBP5 variations have been associated with increased risk of post traumatic stress disorder (PTSD), major depression and other stress-related conditions.

For their study, Dr. Maiarù and colleagues set out to gain a better understanding of how FKBP5 variations contribute to chronic pain.

Blocking FKBP51 protein reduced chronic pain in mice

To reach their findings, the team analyzed mice that were genetically modified to lack a protein called FKBP51 - a variation of the FKBP5 gene - which is known to play a key role in stress regulation.

The researchers found that mice lacking FKBP51 showed reduced pain sensitivity in response to nerve damage and arthritis. 

"Inhibiting FKBP51 has a very powerful effect in mice with chronic pain," says Dr, Maiarù. "Not only does it block the pain from their injury without affecting their normal pain response, it also makes them more mobile. We did not find any negative side-effects."

Next, the team blocked FKBP51 in the spinal cord of normal mice using SAFit2, a compound developed by researchers from the Max Planck Institute of Psychiatry in Germany to treat mood disorders. 

SAFit2 normally works by blocking FKBP51 in the brain to reduce anxiety. By using the compound to selectively block FKBP51 in the rodents' spinal cords, however, Dr. Maiarù and colleagues were able to test its effect on chronic pain aside from its impact on the brain.

The researchers found that SAFit2 significantly reduced chronic pain in the mice, meaning the compound could hold promise as a candidate for drug development.

Senior author Dr. Sandrine Géranton, also of the Department of Cell & Development Biology at UCL, comments:

"The compound was designed to have positive effects on mental health, but we have discovered that it also has significant benefits for physical pain syndromes. Who wouldn't want a treatment that relieves chronic pain while also making you less stressed?

This was an experimental study with mice, but if this could be successfully translated into a treatment for patients, it would be a win-win."

Furthermore, the researchers found that an injury induces prolonged epigenetic changes in the sensory circuits of the spinal cord, which increases FKBP51 production. The team believes this plays a role in the body's response to pain.

"FKBP51 in the brain can prolong the stress response after trauma and we have found that it also exacerbates the pain response," explains Dr. Géranton. "Although this may have once had an evolutionary advantage in promoting survival, in our current lifestyles it can lead to chronic pain, depression and PTSD."

Integrity Life Sciences delivers a multitude of orthotic treatment options to address one of the most costly systemic ailments in the world, chronic low back and neck pain. Our advanced solution begins with the Integrity Spinal Care System (ISCS) ™ and its proprietary iELCiPS Technology™. The ISCS non-surgical spinal decompression modality systems are engineered to provide pain relief for compressive and degenerative conditions of the spine. Specifically, conditions that may be treated include: neck pain and back pain associated with herniated discs, protruding discs, degenerative disc disease, posterior facet syndrome, and sciatica. It achieves these effects through decompression of intervertebral discs, that is, unloading due to distraction and positioning.

As a compliment to the ISCS, Integrity offers the very effective Integrity Gel Support Brace™. Our advanced lumbar support brace is a fitting compliment to non-surgical spinal decompression therapy and was designed as an adjunct therapy for those suffering from back pain due to disc related conditions. The Integrity Gel Support Brace may be used with or without Integrity's non-surgical spinal decompression systems and is an excellent treatment option for the patient to use at home.

In addition, Integrity Life Sciences has been exclusively granted the use of all of the technology, products, US Patent and Trademark Office’s assignments, logos and other forms of intellectual property that were created by Axiom Worldwide, INC under the leadership of Jim Gibson from Tampa, Florida. The agreement specifically includes the flagship product DRX9000™, its family of products, and all of its derivatives such as the DRX9000C. Integrity offers support for these products, which includes: sales, maintenance services, and repairs. Only Integrity Life Sciences is Registered with the US FDA as a Factory Authorized - Contract Manufacturer - for Axiom Worldwide and the DRX9000 True Non-Surgical Spinal Decompression Systems™

James Gibson, President of Integrity Life Sciences and Axiom Worldwide states "Our partners, in over 50 countries and territories, have the unique opportunity to present a cutting edge medical device, utilizing a clinically validated protocol that restores a patient’s quality of life non-surgically and without pharmaceutical or invasive intervention". With a body of published clinical research from around the world will support and strengthen your sales presentation; members of our medical advisory board herald from prestigious institutions such as Johns-Hopkins and The Mayo Clinic just to name a few. In addition, partners will have confidence in a quality product that adheres to the stringent standards mandated by FDA, CE, and ISO. Sales, marketing, and technical training is offered in prestigious locations in Europe, Asia, the Middle East and throughout the United States. 

Learn more @: www.IntegrityLifeSciences.com or www.AxiomWorldwide.com

Integrity Life Sciences, LLC and Axiom Worldwide, INC are privately held companies with global partners and shareholders USA based company with international partners located across the globe with a mission of "Restoring Integrity to the Spine™". 

For additional information please visit: www.IntegrityLifeSciences.com. 

Elements as Published in: Medical News Today

Systematic review of the cost-effectiveness of implementing guidelines on low back pain management in primary care

Abstract

Objective The primary aim is to identify, summarise and quality assess the available literature on the cost-effectiveness of implementing low back pain guidelines in primary care. The secondary aim is to assess the transferability of the results to determine whether the identified studies can be included in a comparison with a Danish implementation study to establish which strategy procures most value for money.

Design Systematic review.

Data sources The search was conducted in Embase, PubMed, Cochrane Library, NHS Economic Evaluation Database, Scopus, CINAHL and EconLit. No restrictions were made concerning language, year of publication or publication type. The bibliographies of the included studies were searched for any studies not captured in the literature search.

Eligibility criteria for selecting studies To be included, a study must be: (1) based on a randomised controlled trial comparing implementation strategies, (2) the guideline must concern treatment of low back pain in primary care and (3) the economic evaluation should contain primary data on cost and cost-effectiveness.

Results The title and abstract were assessed for 308 studies; of these, three studies were found eligible for inclusion. The Consensus Health Economic Criteria (CHEC) list showed that the 3 studies were of moderate methodological quality while application of Welte's model showed that cost results from two studies could, with adjustments, be transferred to a Danish setting. It was questionable whether the associated effects could be transferred.

Conclusions Despite the resemblance of the implementation strategies, the 3 studies report conflicting results on cost-effectiveness. This review showed that transferring the results from the identified studies is not straightforward and underlines the importance of transparent reporting. Future research should focus on transferability of effects, for example, development of a supplement to Welte's model.

Integrity Life Sciences delivers a multitude of orthotic treatment options to address one of the most costly systemic ailments in the world, chronic low back and neck pain. Our advanced solution begins with the Integrity Spinal Care System (ISCS) ™ and its proprietary iELCiPS Technology™. The ISCS non-surgical spinal decompression modality systems are engineered to provide pain relief for compressive and degenerative conditions of the spine. Specifically, conditions that may be treated include: neck pain and back pain associated with herniated discs, protruding discs, degenerative disc disease, posterior facet syndrome, and sciatica. It achieves these effects through decompression of intervertebral discs, that is, unloading due to distraction and positioning.

As a compliment to the ISCS, Integrity offers the very effective Integrity Gel Support Brace™. Our advanced lumbar support brace is a fitting compliment to non-surgical spinal decompression therapy and was designed as an adjunct therapy for those suffering from back pain due to disc related conditions. The Integrity Gel Support Brace may be used with or without Integrity's non-surgical spinal decompression systems and is an excellent treatment option for the patient to use at home.

In addition, Integrity Life Sciences has been exclusively granted the use of all of the technology, products, US Patent and Trademark Office’s assignments, logos and other forms of intellectual property that were created by Axiom Worldwide, INC under the leadership of Jim Gibson from Tampa, Florida. The agreement specifically includes the flagship product DRX9000™, its family of products, and all of its derivatives such as the DRX9000C. Integrity offers support for these products, which includes: sales, maintenance services, and repairs. Only Integrity Life Sciences is Registered with the US FDA as a Factory Authorized - Contract Manufacturer - for Axiom Worldwide and the DRX9000 True Non-Surgical Spinal Decompression Systems™

James Gibson, President of Integrity Life Sciences and Axiom Worldwide states "Our partners, in over 50 countries and territories, have the unique opportunity to present a cutting edge medical device, utilizing a clinically validated protocol that restores a patient’s quality of life non-surgically and without pharmaceutical or invasive intervention". With a body of published clinical research from around the world will support and strengthen your sales presentation; members of our medical advisory board herald from prestigious institutions such as Johns-Hopkins and The Mayo Clinic just to name a few. In addition, partners will have confidence in a quality product that adheres to the stringent standards mandated by FDA, CE, and ISO. Sales, marketing, and technical training is offered in prestigious locations in Europe, Asia, the Middle East and throughout the United States. 

Learn more @: www.IntegrityLifeSciences.com or www.AxiomWorldwide.com

Integrity Life Sciences, LLC and Axiom Worldwide, INC are privately held companies with global partners and shareholders USA based company with international partners located across the globe with a mission of "Restoring Integrity to the Spine™". 

For additional information please visit: www.IntegrityLifeSciences.com. 

Elements as Published in: BMJ British Medical Journal

Updated clinical practice guideline issued on chiropractic care for low back pain

The Journal of Manipulative and Physiological Therapeutics (JMPT), the official scientific journal of the American Chiropractic Association (ACA), published an update to a previously issued evidence-based clinical practice guideline on chiropractic management of low-back pain (LBP). The update, which revised and combined three previous guidelines, supports that doctors of chiropractic (DCs) are well-suited to diagnose, treat, co-manage and manage the treatment of patients with low-back disorders.

Clinical practice guidelines require regular updating to be considered current. To that end, a formal systematic review of LBP literature was conducted for the current update using the Delphi technique and included 37 panelists, of whom 89 percent had worked in private practice for an average of 27 years. Panelist consensus was reached after one round of revisions; the vast majority of recommendations remained unchanged. The previous Council on Chiropractic Guidelines and Practice Parameters guidelines were developed in 2008 and expanded twice over the intervening years.

The updated guideline provides recommendations throughout the continuum of care from acute to chronic and offers the chiropractic profession an up-to-date evidence -- and clinical practice experience-informed resource outlining best practice approaches for the treatment of patients with LBP. Key recommendations are as follows:

• Routine imaging or other diagnostic tests are not recommended for patients with non-specific LBP. Imaging is indicated in the presence of severe and/or progressive neurologic deficits or if the history or physical exam causes suspicion of serious underlying pathology.
• The hierarchy of clinical methods used should generally correspond to the existing level of evidence (i.e., use treatments that are well-supported by evidence first, before moving on to other treatments that are less supported by evidence but that have been shown to be effective through practitioner experience).
• Active care (exercise) clinical strategies can aid in functional recovery from a re-conditioning perspective and also to improve "locus of control" (promoting patient self-reliance) from a psychosocial perspective.
• Informed consent should be obtained from the patient. The diagnosis, exam and any proposed procedures should be explained clearly. Any material risks associated with the proposed treatment should be reviewed (the definition of what is a "material risk" can vary depending on the state), as well as risks associated with other treatment options and the risk of doing nothing.
• Evidence reviewed does not generally support the use of therapeutic modalities (ultrasound, electrical stimulation, etc.) in isolation; however their use as part of a passive to active care multimodal approach to LBP management may be warranted based on clinical judgment and patient preferences.

Integrity Life Sciences delivers a multitude of orthotic treatment options to address one of the most costly systemic ailments in the world, chronic low back and neck pain. Our advanced solution begins with the Integrity Spinal Care System (ISCS) ™ and its proprietary iELCiPS Technology™. The ISCS non-surgical spinal decompression modality systems are engineered to provide pain relief for compressive and degenerative conditions of the spine. Specifically, conditions that may be treated include: neck pain and back pain associated with herniated discs, protruding discs, degenerative disc disease, posterior facet syndrome, and sciatica. It achieves these effects through decompression of intervertebral discs, that is, unloading due to distraction and positioning.

As a compliment to the ISCS, Integrity offers the very effective Integrity Gel Support Brace™. Our advanced lumbar support brace is a fitting compliment to non-surgical spinal decompression therapy and was designed as an adjunct therapy for those suffering from back pain due to disc related conditions. The Integrity Gel Support Brace may be used with or without Integrity’s non-surgical spinal decompression systems and is an excellent treatment option for the patient to use at home.

In addition, Integrity Life Sciences has been exclusively granted the use of all of the technology, products, US Patent and Trademark Office’s assignments, logos and other forms of intellectual property that were created by Axiom Worldwide, INC under the leadership of Jim Gibson from Tampa, Florida. The agreement specifically includes the flagship product DRX 9000™, its family of products, and all of its derivatives such as the DRX9000C. Integrity offers support for these products, which includes: sales, maintenance services, and repairs. Only Integrity Life Sciences is Registered with the US FDA as a Factory Authorized – Contract Manufacturer – for Axiom Worldwide and the DRX9000 True Non-Surgical Spinal Decompression Systems™

James Gibson, President of Integrity Life Sciences and Axiom Worldwide states “Our partners, in over 50 countries and territories, have the unique opportunity to present a cutting edge medical device, utilizing a clinically validated protocol that restores a patient’s quality of life non-surgically and without pharmaceutical or invasive intervention“. With a body of published clinical research from around the world will support and strengthen your sales presentation; members of our medical advisory board herald from prestigious institutions such as Johns-Hopkins and The Mayo Clinic just to name a few. In addition, partners will have confidence in a quality product that adheres to the stringent standards mandated by FDA, CE, and ISO. Sales, marketing, and technical training is offered in prestigious locations in Europe, Asia, the Middle East and throughout the United States.

Learn more @: www.IntegrityLifeSciences.com or www.AxiomWorldwide.com

Integrity Life Sciences, LLC and Axiom Worldwide, INC are privately held companies with global interests and shareholders with international partners located across the globe with a mission of “Restoring Integrity to the Spine™” and delivering "True Non-Surgical Spinal Decompression"

For additional information please visit: www.IntegrityLifeSciences.com.

Elements as Published in: The Journal of Manipulative and Physiological Therapeutics (JMPT)