Procedure could provide longer-lasting Parkinson’s treatment
SEE NEURONS, PAGE C-2
Taming Parkinson’s disease involves controlling the interaction among brain cells (neurons) in the basal ganglia — the part of the central brain shaped like the @ symbol.
In normal function, the neurons chatter among themselves in a way similar to a crowd talking before a concert. The result is steady brain signaling that produces normal motor function.
Things go wrong when those neurons quit chattering and become synchronized in their signaling, as though the crowd quit chattering and now is clapping in unison. The result is the notable Parkinson’s disease symptom — shaking hands.
“Think of it,” said Aryn Gittis, the Carnegie Mellon University assistant professor of biology. “The synchronization hijacks the basal ganglia, almost like a record that gets stuck, playing over and over again. You have to kick it and get it out of that repeating pattern.”
In a scientific sense, the CMU biologist and her team from CMU, the University of Pittsburgh and the CMU/Pitt Center for the Neural Basis of Cognition, have figured out how to kick the turntable and get the system back to normal function for hours at a time.
The team used optogenetics — using light to affect cells — to turn on and off specific sets of neurons in the basal ganglia with light pulses delivered through an implanted optical fiber. The basal ganglia is an important brain area for voluntary motion control. Normal function was restored by boosting the activity of one set of neurons relative to another set of neurons.
With one bout of stimulation, movement was restored for hours before aberrant neural activity returned.
Published last week in Nature Neuroscience, the Pittsburgh
using the drugs appropriately “should not be unilaterally compelled to wean off opioids,” they said.
Non-drug pain therapies include cognitive behavioral therapy, which has strong evidence supporting it, the authors said. Pain self-management and regular exercise are also helpful. Other practices are gaining positive evidence, such as yoga, mindfulness or meditation therapies, acupuncture, chiropractic and massage. The JAMA article called for more study into how those practices compare with pain-relief drugs.
Ms. Farrell said her pain is stable now because of her medications. She understands many people have lost loved ones to drug overdoses, but opioids are helping people in her situation.
“It’s difficult for people with pain to get out of bed and function. We need opioids. … It’s a dilemma. We don’t know what to do.”
Support groups have helped Ms. Farrell cope with her pain, she said, and she’ll speak about her experience at a free public educational meeting Saturday, held by the nonprofit American ChronicPain Association.
Speakers will cover the multidisciplinary approach to pain, working with health care providers, preparing for the emergency room and education for pain professionals in training. The event, with a free lunch, runs 9:30 a.m. to 4 p.m. Saturday at the Westin Convention Center Hotel, Downtown. Reservations are required: call 1-800-5333231. Medical supply and pharmaceutical companies, including Medtronic and Purdue Pharma, and Google and Highmark are corporate sponsors, according to the website, www.theacpa.org.
The ACPA meeting is held in conjunction with the annual scientific meeting of the American Pain Society, at the Pittsburgh Convention Center Wednesday through Saturday, for scientists and healthcare providers.
Pain research
Looking forward to the pain science sessions is University of Pittsburgh researcher Michael S. Gold, Ph.D., professor of anesthesiology at the Center for Pain Research.
“What we learn in the lab could impact people in the clinic tomorrow,” Mr. Gold said, adding that the pain society was founded “on the notion if we solve pain it will involve interaction between basic science and clinicians.” His lab focuses on mechanisms that underlie pain syndromes such as migraines, temporomandibular disorder and inflammatory bowel disease.
The Pain Society sessions will include a discussion on prescribing opioids for chronic pain — whether over time, it’s better to not offer them because of safety concerns and reduced effectiveness.
“That’s a real conflict,” Mr. Gold said. “Opioids do work for pain, moderate to severe pain.” Treating pain after surgery helps a patient get up and walk around afterward. Postoperative pain that’s not treated effectively, Mr. Gold said, can become chronic.
Living with pain
Ms. Farrell said there was no easy cure for her.
“We all grow up with the attitude that you go to the doctor and see what’s causing the pain, and they’ll fix you. But with many other people, like me, that wasn’t the case.”
She had been living in Monroeville, working as a music educator.
“I loved my job. I kept going back and thinking I’d try again. It was too painful. After three times, I had to give up my career.”
After two years, she was treated at what was then the Harmarville Rehabilitation Hospital in its inpatient pain program, which is no longer available.
“That’s what really saved my life. It got me out of bed, got me to try to live again and somehow function.” Then she joined a support group started by the ACPA.
The members listened to her story and didn’t judge or question why she was there. She started her own support group when she and her family moved to a rural home outside of Kittanning.
Now living in Shaler, she started a new support group that meets in the library of Christ Lutheran Church in Millvale on the second and fourth Monday of each month, from 7 to 9 p.m.
Ms. Farrell said she’s found purpose, after years of tears and prayers: “I loved being with the children, singing and dancing. … It was all gone, out of my control, but I’m here, and I have a good life.”
For more information, go to http://americanpainsociety.