Caregivers Have Witnessed the Coronavirus’s Pain. How Will They Vote?

Over all, he thinks the reaction to the virus was “overkill,” but he also thinks Mr. Trump was wrong to suggest it was “nothing to worry about.”

”He did a terrible job,” Mr. Lohoefer said of Mr. Trump’s handling of the pandemic. “But everybody did a terrible job.”

As the virus spread across her facility, Ms. Frazier, the caretaker who witnessed dozens of deaths, said she would see Mr. Trump on television without a mask and grow frustrated. And although she has voted for Republicans and had been a fan of Mr. Trump’s when he was on reality television, she began to blame his cavalier response for her worsening situation at work.

Americans, she came to believe, would not act until the virus affected them personally.

“If we want to make America great again, then we need to change the political face of our country,” she said, noting that she has made a point of discussing her view of Mr. Trump with Republican friends. Ms. Frazier said she would vote for Mr. Biden somewhat begrudgingly, mostly as a vote against Mr. Trump.

“I can’t even tell this story without having a tear coming down my face,” she added. “How can you, as the leader of our country, stand in front of our thousands and not show emotion?”

Ms. Frazier began to cry as she recalled her final moments in April with a resident with whom she had built a rapport over several years.

During better times, the woman assumed the role of floor matriarch. She was “sassy,” and would tell you “exactly what she felt,” Ms. Frazier said. Sometimes, when she had a spare moment during her shift, Ms. Frazier would pop by and say “Hey, beautiful!” — and the woman would beam.

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Acupuncture Helped People With Back Pain Walk and Bend Better

A double-blinded randomized trial of electroacupuncture found it may result in a modest improvement in daily functioning for those with chronic back pain, though it provided little pain relief.

Electroacupuncture uses a small electric current passed between needles, a practice some believe provides additional pain relief compared with regular acupuncture. Researchers tested the procedure by dividing 121 people with chronic low back pain into two groups. The first received electroacupuncture, and the second a sham version of the procedure. None of the patients knew in advance which treatment they would get. The study, in JAMA Network Open, included 12 45-minute sessions over six weeks.

The scientists measured pain intensity using a pain scale developed by the National Institutes of Health, administering the questionnaire two weeks before and two weeks after the end of the treatment. There was no statistically significant difference in pain intensity between the treatment and the placebo groups at either time point. But the acupuncture group did have modest improvement in disability — they reported improvements in walking comfortably, standing for longer periods, bending or kneeling, and other daily activities.

“For back pain management, most techniques, even surgery, provide modest relief,” said the lead author, Dr. Jiang-Ti Kong, an anesthesiologist at the Stanford University School of Medicine. “To manage back pain it’s best to use a multimodal approach, and electroacupuncture can provide a modest, but clinically significant reduction in disability.”

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SBRT Doubles Pain Response Over Usual RT in Spinal Metastases

A 2-day course of high-dose stereotactic body radiotherapy (SBRT) doubles the complete pain response for patients with painful spinal metastases in comparison with conventional palliative radiotherapy. It is also safe and nondestabilizing, conclude researchers reporting a phase 3 Canadian trial.

“Conventional radiation has historically not achieved high rates of complete response to pain or long-term local control,” commented lead author Arjun Sahgal, MD. “So many years ago, we started building on the idea of using high-dose stereotactic body radiation for the spine.”

Sahgal, who is professor and deputy chief of radiation oncology at Sunnybrook Health Sciences Center, the University of Toronto, Ontario, Canada, explained that his team came up with a plan to use SBRT with 24 Gy in two fractions. This involves only two consecutive treatments, which is very convenient for patients. Conventional radiation requires five or more sessions.

“Now we have shown a doubling of the complete response rate to pain at 3 and 6 months compared with conventional palliative radiation, and patients appreciate fewer treatment sessions, too, so we are helping our patients financially,” Shagal told Medscape Medical News.

He presented the new results during the virtual annual meeting of the American Society for Radiation Oncology (ASTRO).

Patients enrolled in this trial had de novo painful spinal metastases with three or fewer consecutive metastatically involved spinal segments arising from a primary tumor causing pain that was scored at least 2 on the Brief Pain Inventory.

The median baseline worst pain score was 5 in a range of 2 to 10. The median total spinal instability and neoplasia score (SINS) was 7 in a range of 3 to 12, Sahgal noted. “The primary endpoint was complete pain response rate at 3 months,” Sahgal told a press briefing held within the context of the virtual meeting.

Patients were randomly assigned to receive either SBRT with 24 Gy delivered in two fractions over 2 consecutive days or conventional palliative radiotherapy with 20 Gy delivered in five fractions.

Initially, the trial was launched as a phase 2 study, but once investigators could demonstrate that accrual was possible, they converted the trial into a phase 3 study, Sahgal noted.

A total of 114 patients were enrolled in the SBRT arm; 115 patients were enrolled in the conventional radiotherapy arm. All were included in the intent-to-treat analysis. “We found that at 3 months, the complete response rate was 35% in the SBRT arm and 14% in the conventional radiation arm, and the difference was statistically significant,” Sahgal reported.

The complete response rate was sustained at 6 months. It remained at 32% in the SBRT arm and 16% in the conventional radiotherapy arm. There was also a reduction in the total SINS score at 6 months that favored the SBRT arm.

Adjusted for age, sex, performance status, primary cancer, and total baseline SINS, SBRT was almost 3.5-fold more likely to result in a complete pain response rate at 3 months and was about 2.5-fold more likely to yield the same response at 6 months

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Dr. Fauci warns of a ‘whole lot of pain’ due to coronavirus pandemic in the coming months

White House coronavirus advisor Dr. Anthony Fauci told CNBC in an interview Wednesday that the United States is “going in the wrong direction” as coronavirus cases rise in 47 states and infected patients overwhelm hospitals across the country.

“If things do not change, if they continue on the course we’re on, there’s gonna be a whole lot of pain in this country with regard to additional cases and hospitalizations, and deaths,” the White House coronavirus taskforce member said in an interview Wednesday evening on “The News with Shepard Smith.”

States in the northeast held the virus in check over the summer, but are seeing cases climb again. New York topped half a million confirmed cases while hospitalizations in New Jersey crossed 1,000 for the first time since July.

Fauci noted, however, that cities like New York and Philadelphia are more equipped to deal with the surge, whereas locations in the northwest and heartland are going to have a more difficult time with the pandemic.

“They never had the kind of hospital and intensive care facility and flexibility that some of the larger hospitals in larger cities have,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. “They’re concerned that if the trajectory continues, they may be in a position where they are going to be strapped for things like intensive care beds,” said Fauci.

In the Midwest, cases and hospitalizations are surging at record numbers. Wisconsin had a 7-day positivity rate of 28% while Minnesota reported its highest number of Covid-19 hospitalizations to-date. Hospitalizations have tripled in less than three weeks in El Paso, Texas. Joel Hendricks, the Chief Medical Officer at El Paso’s University Medical Center even warned about the possibility of rationing hospital care there during an interview with NBC’S Gabe Gutierrez.

“Rationing of care is the worst thing doctors ever want to talk about,” said Hendricks. “Having said that, we have looked at that, we’re in the process of looking at that.”

Dr. Fauci told Smith that he doesn’t foresee the United States taking the same lockdown measures that Melbourne, Australia took to curb its summer spike in cases. Melbourne only reopened Wednesday after spending three months shutdown.

“There is very little appetite for a lockdown in this country,” said Fauci. “There’s going to be major pushback both from above and at the local level, however, what Melbourne did, what Australia did as a country, was very successful.”

Dr. Fauci suggested doubling down on masks, distancing, and avoiding crowds and congregations amid Americans’ coronavirus fatigue, and added that the country would “be much better than we’re doing right now.”

For more of Dr. Anthony Fauci’s interview with Shepard Smith, watch the full interview above.

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Coronavirus may dull the body’s pain receptors, helping the unsuspecting spread it, study says

Rajesh Khanna; COVID-19
Rajesh Khanna; COVID-19

Rajesh Khanna (background) unidentified scientist in foreground Kris Hanning via University of Arizona

This article originally appeared here on Salon.com

A new study from University of Arizona Health Sciences found that SARS-CoV-2 (the virus which causes COVID-19) may actually have a pain-diminishing effect on those it infects, particularly in the initial phase of infection.

The finding may partially explain how the virus is able to so easily spread from people who think they are perfectly healthy, yet are actually pre-symptomatic. The study was published this month in the scientific journal of the International Association for the Study of Pain. 

Specifically, the researchers believe that the novel coronavirus co-opts a specific pain receptor in the body, effectively co-opting it and thus reducing the experience of pain in the body. 

While generally, less pain is better in medicine, the authors of this study note that this behavior by the virus is not necessarily a good thing. “A ‘silencing’ of pain via subversion of VEGF-A/NRP-1 [the receptor in question] signaling may underlie increased disease transmission in asymptomatic individuals,” the authors conclude. In other words, someone with the virus might feel well and fine thanks to the way the virus is co-opting their experience of pain. 

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“There are many people being infected with Covid across the globe and it comes to our realization, in the last few months or so, that there are some symptoms that people experienced that are affecting the nervous system,” Dr. Rajesh Khanna, lead author and corresponding author and professor of pharmacology at the University of Arizona Health Sciences Center, told Salon. “People have been complaining of headaches, muscle pains, joint pain, brain fog, loss of taste and smell. All of these things have been coming and being recorded. And so what we’re adding to this litany of symptoms is the idea, in the initial stages, when you don’t have full blown COVID-19, when you’re perhaps asymptomatic or presymptomatic, you have this fact where the virus itself is giving you pain relief.”

He added, “So you’re feeling like you have no pain, which means that you are — quite wittingly, perhaps — spreading the virus. So that’s really the point of our finding, which is that you’re getting this unwanted or surreptitious kind of pain relief that’s being provided by this virus early on.”

If more studies bear out the findings of the Arizona researchers, it would constitute another way that the virus seems to cleverly encourage transmission before patients know that they are infected. 

Dr. Henry F. Raymond, an epidemiologist at the Rutgers School of Public Health, previously told Salon that the novel coronavirus appeared to be in a class of infectious disease that spread before the original infected person is aware of being infected. “Depending on the person someone could become infected with SARS-CoV2 and never exhibit symptoms but still shed virus in respiratory excretions,” Raymond told Salon. “We should assume there is potential asymptomatic spread and take the necessary precautions

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Schenectady practice helping to eliminate nerve pain

SCHENECTADY — Cyndie Powell loves to cook.

But her lower back pain and sciatica were so bad that she had to sit on a stool in her kitchen in order to cook. She couldn’t stand the pain from standing after just five minutes.

Powell, a resident of Schuylerville who works as a program manager and financial consultant for 1st Scotia Wealth Management, tried everything to dull the pain.

She tried over-the-counter pain relievers and massage. She visited a chiropractor. And she didn’t want to get surgery.

“Nothing really ever made the pain go away,” Powell said.

Until she met Laura Brown, a physical therapist and massage therapist in Schenectady who earlier this year invested in buying and getting trained to operate a electrical stimulation, or eSTIM, medical device made by a company called Calmare.

The machine has the ability to target five separate parts of the body by sending electronic pulses that “reset” the nerves, making them essentially forget the pain. The device can help with fibromyalgia, migraines, sciatica, neuropathy and what is known as Complex Regional Pain Syndrome.


Brown’s business is known as Capital Region Calmare. She operates the only licensed Calmare facility in the local area. Until now, patients who wanted to try the technology would have to travel to Stony Brook on Long Island. Brown has continued to operate her massage business as well.

“I’ve seen firsthand the extraordinary pain relief it’s provided to individuals who have tried traditional treatments, sometimes for years, without success,” Brown said, “There is no better feeling than giving someone his or her life back by re-introducing them to a world without pain, and to do so without any side effects, drugs or surgical procedures is a huge benefit.”

The treatment by the device is not covered by insurance, although some of the physical therapy done as part of the treatment is. The initial session when Brown evaluates a patient costs $100, while each subsequent session costs $250, although Brown offers 10 treatments at a discount for $2,000.

Powell, who has been working from home during the pandemic but travels an hour for treatments, said she got relief after each treatment. The pain would come back to a degree after each one.

But after four sessions, Powell said the pain went away for good. And there was no pain or side effects. She says the electronic therapy is a great alternative to opioids that are often prescribed for back pain. Patients often need more than four sessions.

“It was like a miracle,” Powell said.

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Op-Ed: COVID and Chronic Pain

The COVID-19 pandemic has made access to crucial healthcare services a challenge for many patients, especially those with chronic pain.

According to the CDC, chronic pain is one of the most common reasons adults seek medical care. In the United States, an estimated 20.4% (50 million) of adults had chronic pain according to 2016 National Health Interview Survey data.

Chronic pain has been linked to a lack of mobility and daily activity, socioeconomic status, access to healthcare, and opioid dependence. These correlations have recently been intensified as the pandemic has exacerbated income inequity, lack of access to affordable healthcare, and physical and emotional isolation making the treatment of chronic pain even more challenging.

The consequences of not seeking essential medical treatment for chronic pain can be dire. Patients waiting for a medical assessment often report high levels of pain that interfere with their ability to function and reports of severe pain are associated with increased levels of depression in 50% of patients and suicidal thinking in 34.6% of patients. In addition, as chronic pain patients are increasingly isolated many of them are at a higher risk for opioid addiction or overdose.

The pandemic has highlighted the necessity for patient care to encompass an individualized, multi-disciplinary, and multimodal approach that can include both telehealth and in-person care. And the multidimensional complexity of chronic pain with both pathophysiologic and psychosocial issues reinforces the need for patients to receive pain care under a physician-led team. Pain medicine physicians are specifically trained over many years through medical school, residency, and subspecialty training to diagnose and manage complex acute and chronic pain conditions, including those with life-threatening illnesses.

Many patients who are prescribed opioids need access to in-person medical treatment as monitoring opioid use is difficult through telemedicine and administering urine drug screenings are most effective and accurate in person. When in-person care is not feasible, it is important for physicians in California, for example, to meet state medical board mandates by documenting a patient’s inability to receive drug testing during the pandemic.

For other patients, telemedicine is a good option — especially those with low mobility or comorbidities — as long as there is a focus on ensuring equitable access as disadvantaged groups, older adults, and people with disabilities tend to use technology less often.

Future legislation must not create barriers for chronic pain patients to receive safe, effective treatment. The CDC has already issued guidelines for both opioid and nonopioid treatments for chronic pain. Regulations need to ensure and allow for individualized pain management strategies for patients dealing with chronic pain. Those patients who are stable and functional on opioids should be allowed continued access to opioids, just as all patients seeking nonopioid treatments, including interventional pain treatments, such as spinal cord stimulation, peripheral nerve stimulation, and others with high-quality evidence, should be allowed access to those therapies.

As noted in the journal PAIN: “Not treating chronic pain will have consequences for individuals, healthcare systems, and providers in the short- and long-term, increasing

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For joint pain, keeping active can be effective

Osteoarthritis is the most common type, and it happens when the cartilage in the joint breaks down and the surrounding bone develops inflammation. Osteoarthritis becomes more common with age, but you don’t have to just grit your teeth and suffer through it, says Jason McDougall, a professor at Dalhousie University in Canada who specializes in arthritis and pain research.

An array of strategies are available for treating joint pain, ranging from physical therapy to pain medications, injections and surgery, but one of the most effective ways to manage joint discomfort is one that can seem counterintuitive: Keep moving.

If you’re feeling pain in your joints, you might be inclined to lay off them, but that’s one of the worst things you can do, says A. Lynn Millar, a physical therapist and fellow emeritus at the American College of Sports Medicine.

It’s a vicious cycle — it hurts, so you stop moving the area that’s painful, but “immobilization actually causes deterioration in the joints,” Millar says. Hence the saying among physical therapists, “Motion is lotion.” Movement brings nutrients to the joints and keeps them healthy, Millar says. “Everyone wants a magic bullet,” she says, and physical activity is the closest thing we have.

Even if you’ve had an X-ray or MRI that shows arthritic changes in your joint, that shouldn’t dissuade you from exercising. “Your structure isn’t your destiny,” says Greg Lehman, a Toronto-based physiotherapist, chiropractor and clinical educator in physiotherapy.

Turns out, the findings on an imaging test aren’t a good indicator of pain, he says. Imagine going to a ski area and finding all the people 50 and older who were skiing around enjoying themselves. Lehman says that if you gave these skiers a scan of their knees and hips, the “vast majority of them” would have structural changes in their knee and hips without even knowing about it.

For a 2012 study, researchers took MRIs of the knees of 710 people 50 and older and found that nearly 90 percent had at least one feature of osteoarthritis on the MRI, irrespective of whether they had knee pain.

An X-ray or MRI is not a good indicator of whether someone has pain, Lehman says. “It’s not that those changes you can see in a joint or tendon or muscle are irrelevant,” he says, but they are not very good at predicting how someone feels or what they can do.

Joint pain is complicated, and it’s not just about what’s going on with your bones and ligaments, but also how your nervous system is interpreting the signals it’s receiving.

Chemical mediators, such as enzymes and neuropeptides, released into the joint when someone has arthritis can sensitize the nerve endings around it to make them more active than normal. “These signals are translated by the brain as pain,” McDougall says.

Researchers are just starting to characterize the different kinds of chemical mediators that might be involved in these pain signals, he says.

Most people with joint pain respond well to physical

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Treatment of Back and Joint Pain in Chinese Medicine

Anyone who has experienced a painful injury is all too familiar with its consequences, especially the accompanying unpleasant sensation and loss of mobility. Pain is the most frequent reason for physician consultations in the United States and results in half of all Americans to seek medical care annually. Chronic pain is the third most common healthcare problem and impacts productivity, mobility, and quality of life.

Pain relates to a sensation that hurts. If you feel pain it hurts, you feel discomfort, distress and perhaps agony, depending on the severity of it. Pain can be steady and constant, in which case it may be an ache. It might be a throbbing pain – a pulsating pain. The pain could have a pinching sensation, or a stabbing one. Only the person who is experiencing the pain can describe it properly. Pain is a very individual experience.

This article highlights several of the herbal formulas and supplements we use frequently in the clinic to help alleviate acute or chronic pain

In Chinese medicine, physical injuries, whether old or new, are considered to involve a blood stasis syndrome. When something doesn't move, it creates a logjam and discomfort. The quality of the pain depends on what is being blocked-blood, Qi, yang, etc. Injuries which do not heal within a typical time-a few weeks-may become complicated by other syndromes, both constitutional (eg, blood deficiency, qi stagnation) and circumstantial (eg, invasion of wind or damp).

Often when patients complain of pain in any part of an extremity, including shoulder, elbow, wrist, knees, etc., I often pick an appropriate formula such as Pueraria 10 or Angelica 14 which may be appropriate for shoulder, neck, and head pain , with their focus on dispelling wind and regulating qi. For weakness and inflammation of tendons, Acanthopanax 10 provides pain relief and tonification to aid in strengthening activities.

For traumatic injuries such as exercise injuries, or falls I consider formulas such as San Qi 17 and Myrrh Tablets which are blood moving and blood vitalizing formulas. Both formulas include myrrh, frankincense, persica, carthamus, tang-kuei, peony (white or red), cinnamon twig, and curcuma.

Repetitive stress, old injuries, and persisting joint pain are usually treated by adding tonification along with herbs that counter the invasion of wind. Joint problems can be treated by Chiang-huo 13 for wind-damp accumulation or Drynaria 12 for deficiency syndrome.

For low back pain, I would consider a formula such as Eucommia 18 coupled with Acanthopanax 10. Eucommia 18 contains many tonifying and blood moving herbs. In many instances low back pain consists of tight or knotted muscles. The treatment principle is to remove toxins, nourish the blood and relax the muscle and tendons.

Chinese herbs, Acupuncture, cupping, massage, relaxation techniques, and dietary changes, are some of the many things you can do to help you find relief from your pain.

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