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Alzheimer's May Hamper Ability to Perceive Pain

People With the Disease, However, Don't Have Higher Tolerance for Pain, Study Shows

HealthDay News: Alzheimer's disease may affect people's ability to recognize when they are in pain, a new study shows. Undetected pain may allow underlying health issues to go untreated, leading to serious complications, such as organ damage, researchers from Vanderbilt University in Nashville cautioned. For the 3-year study, the researchers tested two groups of adults who were aged 65 or older. One group was made up of people diagnosed with Alzheimer's disease, which affects thinking skills, memory, and intellect. Members of the second group did not have the progressive neurological disease. The study used a device to subject participants to different heat sensations and asked them to report their pain levels. After the tests, the researchers analyzed self-reported pain. "We found that participants with Alzheimer's disease required higher temperatures to report sensing warmth, mild pain and moderate pain than the other participants," said study first author Todd Monroe, an assistant professor at Vanderbilt's School of Nursing. "What we didn't find was a difference between the two groups in reporting how unpleasant the sensations were at any level." Participants with Alzheimer's were less able to recognize when they were in pain, but their pain tolerance was not diminished, the study found. "While we found that their ability to detect pain was reduced, we found no evidence that people with Alzheimer's disease are less distressed by pain nor that pain becomes less unpleasant as their disease worsens," Monroe said in a university news release. More studies are needed to explore pain perception among those with Alzheimer's disease, the researchers said. They added that doctors should use a variety of methods to evaluate patients' level of discomfort, including pain scales, behavioral changes, and nonverbal cues, like facial expressions. This is particularly important once Alzheimer's patients begin having problems with verbal communication, the study authors said. "As people age, the risk of developing pain increases, and as the population of older adults continues to grow, so will the number of people diagnosed with Alzheimer's disease," Monroe said. "We need to find ways to improve pain care in people with all forms of dementia and help alleviate unnecessary suffering in this highly vulnerable population." The study findings were published in the journal BMC Medicine.

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Doctors Urged to Prescribe Lower Doses of Opioids, No Refills

Researchers Cite Concerns About Possible Long-term Use and Addiction

HealthDay News: Patients who are first-time users of pain-killing opioids should be prescribed a small dose without refills to reduce the risk of long-term use and possible addiction, a new study suggests. A surge in prescriptions for opioids such as Oxycontin and Vicodin over the past 2 decades dovetails with a steep rise in addiction and overdoses in the United States. The trend has prompted calls for more careful use of the narcotic pain-killers. Researchers analyzed data from nearly 537,000 patients in Oregon who were prescribed opioids for the first time. The investigators found that 5% of those who received six or more refills within a year became long-term users. This trend was higher among rural patients (6%) than among urban patients (4%), the findings showed. And the risk of long-term use increased with age, according to the study published in the Journal of General Internal Medicine. Further study of data from more than 243,000 patients aged 45 and younger found that those who were given two prescription fills were 2.25 times more likely to become long-term opioid users than those who received one prescription. The risk was also greater among patients who got higher initial doses and long-acting rather than short-acting medications, the findings showed. The risk of long-term use can be reduced by prescribing a short-acting pain-killer with no refills, according to study leader Richard Deyo. He is a professor of evidence-based medicine at Oregon Health & Science University in Portland. "The increasing risk of long-term use even at low cumulative doses supports the Centers for Disease Control recommendation of limiting therapy to three to seven days for most patients," Deyo said in a journal news release. "Our data suggest the value of attention to high-risk prescribing, over which clinicians have greater control. This in part reflects concern that we are dealing with risky drugs, not risky patients," he said.

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Study Also Found Association Between Prolonged Exposure to Loud Noises and Tinnitus

HealthDay News: One in 10 Americans has experienced ringing in the ears, a condition called tinnitus, and that is likely the result of prolonged exposure to loud noises, new research suggests. Tinnitus is characterized by hearing sounds when there are none. The sounds can be perceived as ringing, buzzing, crickets, or hissing. For those who struggle with it on a daily basis, the noise is so bothersome that it interferes with thinking, emotions, hearing, sleep, and concentration, the researchers said. In the study, "durations of occupational and leisure-time noise exposures correlated with rates of tinnitus and, accordingly, there are likely correctable risk factors that can be addressed in the workplace and at home," said lead researcher Dr. Harrison Lin. But guidelines for treating tinnitus are rarely followed, and "consequently there is considerable room for improvement in the care provided by health care professionals for patients with chronic, bothersome tinnitus," Lin added. "Noise exposures at work and at home seem to correlate with the prevalence of chronic tinnitus, and accordingly these noise exposures should be addressed and minimized," he said. But the study did not prove that such exposure caused the condition. For the study, Lin and his colleagues evaluated data on nearly 76,000 adults who took part in the 2007 National Health Interview Survey. Using that sample to estimate the prevalence of tinnitus in the entire U.S. population, the researchers estimated that nearly 10% of adults suffer from tinnitus. Among those with tinnitus, 27% had symptoms for more than 15 years, and 36% had nearly constant symptoms, the researchers found. Fifteen percent had symptoms at least once a day, whereas over 14% had symptoms at least once a week. The rest had symptoms less than weekly. Tinnitus was most common among those with consistent exposure to loud noises at work and during leisure time. About 7% said tinnitus was a "big or a very big problem," compared with 42% who said it was a "small problem." The report was published in the journal JAMA Otolaryngology-Head & Neck Surgery.


Health Insurance Status May Affect Cancer Patients' Survival

HealthDay News: Two large studies suggest that surviving certain cancers in America could depend on your health insurance status. Despite improvements in cancer diagnosis and treatment, patients who were uninsured or had Medicaid coverage were more likely to suffer worse outcomes, compared with people who have other forms of health insurance, the studies found. People who were uninsured or relied on Medicaid were diagnosed at a later stage, received suboptimal treatment, and had shorter survival, the findings showed. In the case of testicular cancer, they were at greater risk of death from their disease than patients with other insurance, the researchers found. The findings, published in the journal Cancer, add to evidence linking poor outcomes and inadequate health insurance. Dr. Christopher Sweeney, a medical oncologist at the Dana-Farber Cancer Institute in Boston, is an author of the study examining testicular cancer. Some cancers have a biologic component, where ethnicity may play a role, he explained. In this case, though, "the only thing that stood out strongly as a predictor of those who did poorly was the insurance status." Sweeney and colleagues identified more than 10,000 men diagnosed with testicular cancer between 2007 and 2011. The investigators found that uninsured men and patients with Medicaid coverage were at higher risk of being diagnosed with stage II or stage III metastatic disease, and of having larger tumors at diagnosis than men with other insurance. Among those with metastatic disease, uninsured and Medicaid patients were more likely to have more advanced cancer. "What it means is probably the cancer had been percolating and brewing for longer by the time the patient was diagnosed," Sweeney said. The study found that uninsured and Medicaid patients with early-stage disease were less likely to have their lymph nodes removed, a procedure that may cure some patients. Among patients with advanced disease, the uninsured were less likely to have radiation therapy. The uninsured and Medicaid patients were more likely to die of their disease and also had a higher risk of death from all causes than men with other insurance, the researchers reported. The other study involved more than 13,600 patients diagnosed between 2007 and 2012 with glioblastoma, the most common type of brain tumor in adults. Again, uninsured and Medicaid patients were diagnosed with larger tumors. Medicaid patients were less likely to have surgery to remove tumors, even though it's the baseline treatment for this cancer, the study found, and uninsured and Medicaid patients were less likely to have radiation therapy. Even after adjusting for multiple factors that might influence the results, having Medicaid or being uninsured was linked to shorter survival. Only patients with other insurance showed gains in survival over time, with patients diagnosed in 2012 living longer than those diagnosed in 2007.

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