Mechanism Discovered Which Can Explain Female Resistance to Opiate-Class Analgesics

So, this is a fascinating development in pain research. This is, in my estimation, the textbook definition of a double-edged sword.

To nutshell: Neuroscientists at Georgia State University have discovered the mechanism by which female brains literally do not respond to morphine the same way as male brains.  Miroglial cells (the brain's immune response) view morphine as a pathogen in the brain and so work hard to clean it up (therefore rendering the morphine less effective for analgesia); and these cells are more active in female brains than male brains. Suppressing these cells makes morphine work better - which is why it doesn't work for females as well as males.

Here's the pointy bits of that sword, as I see them: There is no discussion (that I know of - but please tell me if I'm wrong!) as to what the effects are (short term or long term) of suppressing one of the brain's immune responses. Does this have an effect on the body's immune response? Does it mean the brain is left more vulnerable to actual pathogens? This is promising and powerful but these questions need to be answered.

On the other hand, here's the good bits: There is now a known mechanism by which female brains process morphine differently. Women who need more pain relief compared to men of similar body weight are not "weak" or "whining" or "hysterical". Females literally clear that shit out of the synaptic gaps faster, thank you very much.

So be a good doctor and give the lady her morphine.



UC Professor Daniel Goldberg Illuminates Historical Trends of Pain Stigmatization

Daniel Goldberg is an Associate Professor at the University of Colorado's Center for Bioethics and Humanities, and he has released a new paper "Pain, objectivity, and history: understanding pain stigma* which not only argues the importance of understanding historical context of chronic pain treatment, but helps place it there. 

He is interviewed by Sara Zhang in this Atlantic article, I found it very worth the read. 

One of the more salient points, to me, is the double-edged sword of medical objectivity especially related to imaging and testing technology. We want, in modern Western medicine, to be able to attribute Symptom A with Pathology A - and for many chronic pain patients, the subjective pain is very very real but the objective findings are elusive. The diagnoses backed up by tests or images carry greater legitimacy and therefore less likely to be stigmatised as some variation of 'malingering'.  

This effects not only how pain sufferers are treated by other people, but how pain sufferers treat themselves.  

From Zhang's interview:

Patients want medical imaging, especially people dealing with contested illnesses. Why? Because seeing it confirms the truth of the matter for them. These are the people experiencing it—they don’t have the luxury of denying the reality of their own pain but they kind of do deny the legitimacy of it, especially when everyone else is denying the legitimacy of it.

That’s how stigma works. When everybody else is stigmatizing you for something—day after day, week after week, year after year, guess what? You tend to internalize it. Seeing the image, the pathology, the object confirms the truth of the matter to them.

Unfortunately, even as the objective result can confirm the truth, an objective finding of 'nothing' from an accurate but not omniscient instrument can make the "truth" even more lonely, when someone suffers without "reason".

*(abstract here; full text available through BMJ paywall)

The Atlantic tackles that age-old question of "how much pain?"

I've been thinking a whole lot lately about the 1-10 pain scales, and how they are objectively dicey because scales that aren't anchored are not useful measurements.  My idea of a "5"on my pain scale is, by definition, going to be different than anyone else's - including my doctor, who, being human, may not be able to scrub her version of "5" out of her head before determining a course of treatment.

For a crude and simple analogy of the disconnect, patients are talking in Imperial measurements and the doctors are fluent in Metric.  We can both agree that we we're talking about "5", but the difference between 5 mL and 5 oz is... substantial.

Regardless, here is a really good article that dives into the paradox of the measurement of pain. Kudos, John Walsh, for a fine article.


Reframing the treatment of heroin addiction - a long-overdue view

Zachary Siegel over at Slate writes about the available treatments of heroin (opiate) addiction - and how we're not using the most effective ones because of a stubborn mindset born of a Puritanical streak, a lack of political willpower, and the pernicious belief that 12-step programs are adequate treatment.