Researchers say they’ve figured out an objective way to measure pain -- by imaging the brain’s response, in real time.

They used a type of brain scanner called functional magnetic resonance imaging, or fMRI, to take pictures of people’s responses to pain. And they documented that a morphine-based painkiller reduces both the pain that people reported they felt, and the pain that registered on the brain scan.

The test will be useful not as a pain lie detector test, but as a way to objectively measure pain, treatments for pain, pain in patients who can’t talk or who can’t talk well, and pain in people who are unconscious, the researchers report in the New England Journal of Medicine.

They worked out an algorithm -- a kind of computer equation -- that could directly correlate the brain images with the degree of pain that people felt.

“We can make an accurate prediction about how much pain a person is feeling,” says Tor Dessart Wager of the University of Colorado, who helped lead the four studies detailed on Wednesday.

Other pain experts say the findings look like they will hold up. "I think it will help transform pain medicine," said Dr. David Borsook of Harvard Children's Hospital, an expert on pain imaging.

Wager's team is not the first to try using fMRI to measure pain. Sean Mackey at Stanford University published a similar report in 2011 in the Public Library of Science journal PloS ONE. Irene Tracey, of Britain’s Oxford University, is among several other groups trying to finesse the technique.

Wager’s team, working with colleagues at New York University, Johns Hopkins University and the University of Michigan, got 114 volunteers to agree to have hot plates applied to their arms while undergoing fMRI.

Temperatures went from a pleasantly warm 39 degrees C (102 degrees Fahrenheit) to 49 degrees (120 F).

“We can tell which one was more painful for you with 90- to 100-percent accuracy,” Wager says. The method was so sensitive, he says, that the team, was able to tell, by looking at the fMRI alone, if a volunteer was being touched with a plate at 48 degrees or 49 degrees.

The tests also confirmed that people do perceive pain differently, Wager says. “Let’s say I give you a 48-degrees stimulus and you go ‘This is okay; I can handle it’ and I might say ‘Oh, this really hurts’,” he said. “My brain is going to respond more strongly than yours. We are using this to track what people say they feel.”

It’s an independent way to measure actual pain. “You could be saying you don’t feel so much pain just because you are stoic,” Wager said.

But, Wager said, the scans should not be used to try to prove people are faking pain. He stresses they tested only healthy people who were not feeling pain because of disease or injury. Pain caused by wounds or illness might show up differently, he says. And some types of pain, like the pain caused by fibromyalgia, might affect different brain systems, he says.

“There are different things that people call pain and multiple treatments that influence pain and we think they work through different systems,” Wager says.

“There is really still a mystery about where in all these circuits the experience actually emerges,” he said. “The brain is complicated place. It’s easy to find things that look true but aren’t true.”

Earlier, the team had reported that social pain, such as rejection, causes the brain to activate in much the same way as physical pain. They tested this idea using the fMRI. It totally failed.

“One of the experiments is one in which everybody in the study has been romantically rejected,” Wager said. They brought in pictures of their exes, and confirmed that they were feeling emotional pain when looking at them. But the pain did not show up on the fMRI in the same patterns as physical pain. “It wasn’t fooled at all,” Wager said.

And they were also able to show how pain medications worked. In one of the experiments, volunteers got a morphine-based drug while they were being given near-burns. The brain’s indication of pain changed in direct correlation with the concentration of drug in the brain, they reported.

But then something interesting happened. In one round of experiments, they hooked the volunteers up to a drip and told them they were not getting the pain drug yet. But they were. “We fooled them,” Wager says.

It’s a well-known effect of pain treatment -- when people know they are getting a pain drug, they report less pain. And the brain scan confirmed it. When people did not believe they were getting the pain medication, they reported that the burning hurt more than the brain scan indicated it hurt. In fact, their brain response was the same, whether they knew they were getting the painkillers or not.

Next up, Wager says it will be important to test different types of pain -- pinpricks or cold for example -- and to test people who are experiencing pain caused by disease or injuries.

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Health officials are working to track down everyone who may have been treated with an injection for lower back pain that is linked to an outbreak of rare fungal meningitis.  So far, 35 people have been diagnosed with the infection in six states and five of them have died.

At least 75 clinics in 23 states received batches of the steroid drug from a Massachusetts compounding pharmacy and have been told to notify all affected patients, health officials said.

"Unfortunately, despite the current recall, we expect to see additional cases as this investigation unfolds. However, it is possible if patients are identified soon and started on appropriate antifungal therapy some of the unfortunate consequences may be averted," Dr. Benjamin Park of the U.S. Centers for Disease Control and Prevention told reporters in a telephone briefing.

Food and Drug Administration officials warned health care workers not to use any drugs from the New England Compounding Center in Framingham, Mass., which has voluntarily ceased distribution of all of its products.

The 35 cases include 25 people in Tennessee, one in North Carolina, two in Florida, three in Virginia, two in Maryland, and in Indiana, the CDC reported. Three of the deaths were in Tennessee, one in Virginia and one in Maryland.

"Infected patients have presented approximately one to four weeks following their injection with a variety of symptoms including fever, new or worsening headache, nausea and our new symptoms consistent with a stroke," Park said. "Some of these patients symptoms were very mild in nature. Cerebrospinal fluid obtained from these patients has shown findings consistent with meningitis. It is important to note that this type of meningitis is not transmissible from person-to-person."

Health officials are asking anyone who had a spinal injection for pain and who has symptoms such as a headache, stiff neck, dizziness or trouble walking to see a doctor right away.

The drug is question is called methylprednisone and is used mostly to treat older patients for lower back pain.  Tennessee officials were the first to notice the unusual cases of meningitis, and discovered that the patients involved had all been treated at three specialty clinics. All had recieved direct injections of the steroid into their spines for pain. Women who received epidural infusions for childbirth are not in danger, the officials said.

Health officials have isolated aspergillus from five patients, CDC officials said. In addition, FDA officials detected fungal contamination in an unopened vial of methylprednisolone from one of three lots of 80-milligram injection doses recalled by the New England Compounding Center. 

"Looking under microscopic examination, it was identified as a fungal contaminant. For the sake of time, because we -- everything is unraveling and unfolding very quickly, we have not been able to further microbial testing of additional vials and what is necessary. So, right now, we can only say that it is a foreign material," FDA's Dr. Ilisa Bernstein said.

Everything the pharmacy made is being checked. Berstein said it's not clear how many potentially contaminated vials of steroid were distributed. "But if they are licensed in 50 states, there is a possibility that it could be elsewhere, not just this product, but as well as other products that they have made," she said.

Meningitis is an inflammation of the spinal cord, usually caused by bacteria or viruses. It can be very serious and is marked by a headache, fever, often a stiff neck and balance problems. Fungi and parasites can also cause this inflammation and in this case the common mold aspergillus is suspected.

Aspergillus is tricky to treat. It’s an infection that patients with damaged immune systems can get – notably cancer patients and those with HIV infection. It’s often found in the lungs because the mold – found in dead leaves and elsewhere -- can be breathed in. An antifungal drug called voriconazole can treat the infection but the health officials said in this case they want to be sure before they try it. The side effects from the antifungal treatment can be severe and include kidney and liver damage.

"Currently, we think that this type of meningitis is quite severe as we have been describing here. The antifungal treatment for this is intravenous antifungal treatment and requires initial hospitalization. But the duration of antifungal therapy could be prolonged possibly on the order of months," Park said.

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By Associated Press

The Food and Drug Administration is warning consumers about rare chemical burns reported by people using popular pain relief products like Bengay, Icy Hot and Flexall.

The over-the-counter products are designed to provide short-term relief from minor muscle and joint aches and pains. But regulators say they have received reports of skin injuries ranging from first- to third-degree chemical burns caused by the products. Some of burns have required hospitalization, according to a notice posted to FDA's website.

The agency says consumers should stop using the pain relievers if they experience signs of skin injury, such as pain, swelling or blistering of the skin. Doctors should instruct patients on how to use the products, which come in lotions and patches, correctly.

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M. Spencer Green / AP

By Rachael Rettner, MyHealthNewsDaily

Acupuncture may be modestly better than a placebo for the treatment of chronic pain, a new review suggests.

Researchers analyzed information from nearly 18,000 patients with chronic back, neck or joint pain, or headaches.

Patients who received acupuncture experienced a greater reduction in their pain compared with those who received standard pain treatments without acupuncture, and those who received fake acupuncture treatment, called "sham" acupuncture. The benefit of real acupuncture over sham acupuncture was only slight, the researchers said.

The findings suggest that overall, acupuncture is effective, and is a reasonable treatment option for patients with chronic pain, the researchers said.

Because real acupuncture was superior to sham acupuncture, the results suggest that acupuncture is not completely a placebo, or a treatment that benefits patients simply because they believe it will work, the researchers said.

However, because the difference between real and sham acupuncture was small, it's likely that most of the benefit of acupuncture is indeed due to the placebo effect, the researchers said.

In general, "about a third of the effect of any treatment is a placebo effect," said study researcher Andrew Vickers, of Memorial Sloan-Kettering Cancer Center, in New York City. "In acupuncture, it's more like two-thirds, Vickers said.

Many patients with chronic pain who resort to acupuncture have not responded to standard treatments, or experienced significant side effects from them, Vickers said.

About 3 million Americans receive acupuncture each year, and chronic pain is the most common reason for the therapy, the researchers said. Because researchers have not determined how acupuncture could work to reduce pain, its use is controversial.

In the new study, Vickers and colleagues analyzed information from 17,922 patients who participated in 29 studies conducted in the United States, United Kingdom, Germany, Spain and Sweden. Many previous studies of acupuncture were not rigorously designed, the researchers said, and they excluded these from their analysis.

In the included studies, participants with chronic pain were randomly assigned to receive acupuncture, sham acupuncture or no acupuncture. Their pain was assessed at least four weeks after treatment.

In the sham acupuncture procedures, needles were inserted too shallowly to stimulate an acupuncture point, or using a machine with a tip that causes a prickling sensation, but did not actually push a needle into the skin.

Patients who received acupuncture reported less pain after treatment than those who received no acupuncture or sham acupuncture.

After treatment, the percentage of patients reporting their pain was "much better" was 30 percent for those who received no acupuncture, 42.5 percent for those who received sham acupuncture, and 50 percent for those who received real acupuncture, Vickers said.

The new study gives "some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain," Andrew Avins, a researcher at Kaiser-Permanente in Oakland, Calif., wrote in an editorial accompanying the study.

However, the benefits of acupuncture seem to come primarily from the placebo effect, Avins said, and acupuncture critics will be sure to point this out. After all, drugs are required to perform better than a placebo before they are approved for use, he said.

Still, the performance of a therapy against a placebo is not the only way to measure the treatment's effectiveness, Avins said.

"At the end of the day, our patients seek our help to feel better, and lead longer and more enjoyable lives," Avins said. "Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing," Avins said.

The study and the editorial are published online today (Sept. 10) in the journal Archives of Internal Medicine.

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Many pediatricians don't take kids' pain seriously - particularly when it comes to ear infections and sore throats, writes Dr. Ralph Berberich in Pediatrics.

Wendi Fellner always nursed her baby daughter when she got her childhood immunizations, and that baby has grown into a 9-year-old who’s pretty fearless about shots.

But Fellner, who lives in Winter Park, Fla., will never forget her first -- and last -- visit to the office of a new pediatrician she tried when her daughter was four months old.

The nurse told her it was against the practice’s policy to allow moms to breastfeed babies while they were getting shots. Infants could choke on breast milk if they started crying from the shot, don’t you know?

In fact, the nurse went on, it was against policy for parents even to touch infants who were getting immunized. Liability issues, you know, she told Fellner. What if the parent jumped when the baby screamed?

Policy-schmolicy, Fellner thought. She persuaded the reluctant nurse to bend both of the rules and then quickly found another doctor for her daughter’s next checkup.

Pediatrician Ralph Berberich, who practices in Berkeley, Calif., has heard too many stories like that. Frustrated, Berberich and Dr. Neil Schechter, a pain doctor at Children’s Hospital Boston, wrote an article entitled “Pediatric Office Pain: Crying for Attention,” that will be published next month in Pediatrics. The journal posted the piece online Monday.

Many doctors, and their office staffs, don’t take kids’ pain seriously, Berberich told msnbc.com. They view shots as a rite of childhood that prepares them for a lifetime of doctor-inflicted pain.

“They don’t know that the literature shows there are indeed lasting consequences,” Berberich says. One in 10 adults is phobic about needles, he notes, and you can bet that fear stems from a heavy-handed doctor in childhood.

Even less attention is paid to pain from sore throats and ear infections, Berberich says. “Doctors are very afraid to put medications in the hands of parents and trust that they will know how to use them.”

Study: Sugar water helps newborns' pain

In 2009, Berberich reported in Pediatrics about a method to distract kids from shot pain. It involves a cooling spray on the site of the injection and a vibrating massager that meanders down the other arm.

When the massager reaches their elbow, children are told to say “elbow,” which makes them forget to say “ouch,” Berberich says.

While the method “is very successful,” it requires an extra nurse and perhaps a couple more minutes of time, he says. Ultimately, though, it saves time and money, because he doesn’t have to cajole frightened patients into letting him administer shots.

Parents can help, too. Recent research supports Fellner’s belief that breast milk might be the perfect pain reliever for infants. And, Berberich says, “If the parent says, ‘I would rather have my child in my lap, most pediatricians would agree.”

With toddlers own up; be honest. Don’t say the shot won’t hurt, but also don’t say it will hurt only a little. Best to say “I don’t know how it’s going to feel for you,” and change the subject to what treat you have planned for afterward.

In his practice, Berberich tops off children’s shots with a cookie.

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