Recently research by Michael V. Vitiello at the University of Washington has shown that cognitive behavioural therapy (CBT) improve sleep in people who have osteoarthritis. The study involved 51 participants who were randomly assigned to either a control group or a CBT group. The CBT group received 8 two-hour classes of CBT in small groups (4-8 subjects) whilst the control group received generic wellness classes. After the intervention the CBT group were shown to have significantly improved sleep quality. Interestingly the improvement in sleep was also associated with an improvement in pain.

Cognitive Behavioural Therapy is a form of psychotherapy designed to help change the way people think and behave. Unlike many other psychotherapies that focus on the causes of distress, CBT takes a problem solving approach that focuses on ways to improve your psychological state.

Osteoarthritis (OA) is a condition whereby there is an inflammation of the joint caused by a degeneration of the cartilage that lines the joint. As the cartilage degenerates there can also be changes in the bony surfaces of the joint which can lead to pain and joint dysfunction. Otherwise known as the “wear and tear arthritis” OA is thought to affect an estimated 8.5 million people in the UK. Most commonly, osteoarthritis develops over the age of 50 and is more common in men. Osteoarthritis is more common if there has been some kind of injury to one of the joints. One of the common symptoms of osteoarthritis is night pain which can have a big impact on quality of live.

Acupuncture is a technique that involves inserting and manipulating very fine needles into specific points on the body with the aim of relieving pain. Chinese Acupuncture has been used to treat pain for thousands of years in the Far East. Chinese Acupuncture is increasingly being used today but as demand for this therapy increases, there is also an increasing need to try and understand if and how the therapy works. By understanding the therapeutic effect of Chinese acupuncture it may be possible for scientists to develop more effective protocols that will be more acceptable within mainstream medicine.

Recently, a research team from the University of Michican used a brain imaging technique to try and understand how activity in the brain changes during Chinese Acupuncture. Twenty women who had Fibromyalgia related pain for at least 1 year were recruited to the study. Within this group half the women had the real acupuncture over an 8 week period whilst half received a control intervention. A PET scan was applied before and after the study to analyse the binding availability of different pain receptors in the brain.

Whilst both groups experienced a reduction in pain, the brain activity changes were different. Most notably, there was a change in the binding availability of opioid pain receptors in the Chinese Acupuncture group. Opioids are thought to work by activating these types of receptors and so a change in the binding availability of these types of receptors may alter the way these drugs work. Whilst more research needs to be done in this area, this small study does hint  that acupuncture may have a real physiological effect on pain receptor in the brain.

Phantom limb pain is a chronic condition whereby sufferers experience pain from the site of the amputated limb. Approximately 50-80% of amputees suffer from some degree of phantom limb pain and it occurs independently of gender, side of amputation and age. Phantom limb pain can be difficult to control with drugs which has led researchers to look for other treatment possibilities. One treatment that has been gaining increased recognition in the last 15 years is mirror therapy. Mirror therapy quite simple involves trying to trick the brain into thinking that the missing limb is not actually missing and can be moved. For some people this illusion can provide a significant reduction in phantom limb pain. Quite why this therapy works is still not clear but there is growing evidence to suggest that the therapy normalises abnormal activity in part of the brain that controls and senses the missing limb. One reason why this therapy is so exciting is because unlike drugs it should not have any side effects.

For the first time the National Institute for Health and Clinical Excellence has backed the use of acupuncture, manual therapy and exercises as treatment options for persistent low back pain. The reason why 3 therapies are being offered is because whilst research has shown that acupuncture, manual therapy and exercise can be beneficial for persistent back pain it is not clear if one therapy is superior to the other.

Anyone with persistent back pain for over 9 weeks will be given the normal advice and medication options. In addition, people will be able to choose from a course of acupuncture, manual therapy or exercise. Low back pain is a widespread problem in the UK with an estimated 2.5 million people visiting their GP with the condition

Opioids have been successfully used for pain relief for many years. One of the concerns about opioid prescription has been opioid addiction and abuse. Indeed, some areas of the media have suggested that increased opioid abuse may be caused by a greater numbers of patients being prescribed opioids for chronic pain management. In contrast to these reports, recent evidence suggests that the problem may not be as serious as once thought. In an extensive review of research papers (which included 17 studies of people being treated with opioids for chronic pain) opioid abuse was reported in 0.4% of patients. This finding is particularly important for doctors considering opioid prescription, who can be reassured that only a very small percentage of chronic pain patients are likely to be at risk of opioid abuse.

New research from the Journal of Arthritis and Rheumatism has reported evidence to suggest that as well as being a symptom of osteoarthritis, pain may also cause arthritis. Researchers found that some of the pathways carrying pain signals also transferred inflammation from arthritic joints to the spine and back again. In the experiment, the researchers genetically engineered a mouse where they could turn up and turn down the production of a chemical (IL-1β ) known to be involved in inflammation. Most notably, they found that increasing production of IL-1β at the peripheral joint caused higher levels of IL-1β to be produced in the spinal cord. This finding is important as it may help researchers develop new drug targets to try and prevent the spread of inflammation.