Harnessing Placebo Responses to Improve Health Outcomes.

Variations in the psychosocial aspects of the provision of health care treatments can measurably affect the health outcomes resulting from the use of such treatments. These benefits (or harms) in outcomes result from processes beyond the specific physiological mechanisms induced by the treatments. Such phenomena can be most clearly seen when physiological improvements are induced by administering inert placebo medications in the same manner as if they were actual medications.

Associations Between Diabetes-Related Distress and Cardiovascular Complication Risks in Patients With Type 2 Diabetes and Lower Socioeconomic Status: A Pilot Study.

The purpose of this pilot study was to assess the associations between diabetes-related distress and predicted 10-year risks for cardiovascular complications in a lower-socioeconomic-status population with type 2 diabetes. Diabetes-related distress was found to be significantly associated with the predicted 10-year risk for coronary heart disease in the studied population. In addition, the association between the predicted 10-year risk for stroke and diabetes-related distress was also statistically significant among individuals with lower occupational status scores.

Similar adverse events from two disparate agents implicate lipid inflammatory mediators for a role in anxiety states.

We recently reported a case in which a 54-year-old male experienced maintenance insomnia, generalized anxiety and panic symptoms associated with consumption of a fish oil supplement enriched in eicosapentaenoic acid (EPA). We report here that the same patient has experienced identical but more severe symptoms in response to the use of the leukotriene receptor antagonist montelukast, in accordance with other cases reported to the Food and Drug Administration. Since omega-3 fatty acids like EPA are precursors for the biosynthesis of eicosanoids including leukotrienes, a common factor to these psychiatric adverse events may be perturbations in this highly complex system of lipid inflammatory mediators.

Insomnia and exacerbation of anxiety associated with high-EPA fish oil supplements after successful treatment of depression.

A 54-year-old male consulted his general practitioner for increasing general anxiety and mild panic attacks despite effective treatment for recurrent major depressive disorder, which included a fish oil supplement enriched in eicosapentaenoic acid (EPA). The patient would awaken suddenly at night with shortness of breath and overwhelming worry. During the daytime, he felt a general, nonspecific anxiety and frequently experienced sympathetic activation upon confronting routine challenges.

Ionic basis of a mechanotransduction current in adult rat dorsal root ganglion neurons.

Sensory mechanical transduction - necessary for hearing, proprioception, and the senses of touch and pain - remains poorly understood. In somatosensation, even the basic properties of the mechanically sensitive excitatory ionic currents that are assumed to mediate mechanical transduction are largely undescribed. We have recorded, from the soma of rat dorsal root ganglion (DRG) neurons in vitro, whole-cell ionic currents induced by the impact of a piezo-electrically driven glass probe.

Integrin signaling in inflammatory and neuropathic pain in the rat.

Many painful conditions are associated with alterations in the extracellular matrix (ECM) of affected tissues. While several integrins, the receptors for ECM proteins, are present on sensory neurons that mediate pain, the possible role of these cell adhesion molecules in inflammatory or neuropathic pain has not been explored. We found that the intradermal injection of peptide fragments of domains of laminin and fibronectin important for adhesive signaling selectively inhibited the hyperalgesia caused by prostaglandin E2 (PGE2) and epinephrine (EPI), respectively.

Role of the sensory neuron cytoskeleton in second messenger signaling for inflammatory pain.

Prostaglandin E(2) (PGE(2)) and epinephrine act directly on nociceptors to produce mechanical hyperalgesia through protein kinase A (PKA) alone or through a combination of PKA, protein kinase C epsilon (PKCepsilon), and extracellular signal-regulated kinase (ERK), respectively. Disruptors of the cytoskeleton (microfilaments, microtubules, and intermediate filaments) markedly attenuated the hyperalgesia in rat paws caused by injection of epinephrine or its downstream mediators. In contrast, the hyperalgesia induced by PGE(2) or its mediators was not affected by any of the cytoskeletal disruptors.

Myelotoxicity and dose intensity of chemotherapy: reporting practices from randomized clinical trials.

Delivery of cancer chemotherapy is often limited by myelotoxicity, primarily neutropenia. As part of an effort to create a model to predict the risk of chemotherapy-induced neutropenia, we reviewed the reports of randomized clinical trials with more than 50 patients per arm in early-stage breast cancer (ESBC) and non-Hodgkin's lymphoma (NHL) published between 1990 and 2000. We observed that no hematologic toxicity data were reported in 39% and 34% of the ESBC and NHLtrials, respectively.