Bollywood star Hrithik Roshan,38, struggled with chronic pain for 27 years. He is free of it now, thanks to cutting-edge treatments that spell new hope for managing suffering.Look at the irony of it. I have a broken back, broken knees, I have torn my shoulders six or seven times and,Bollywood star Hrithik Roshan,38, struggled with chronic pain for 27 years. He is free of it now, thanks to cutting-edge treatments that spell new hope for managing suffering.Look at the irony of it. I have a broken back, broken knees, I have torn my shoulders six or seven times and I’m playing a superhero.” That’s 38-year-old actor Hrithik Roshan’s way of poking fun at his intimate enemy of 27 years: Constant and relentless pain. “I don’t remember those days when I did not have any pain.” He was just 11, when his knees hurt and a “strange, shooting pain” often hit him like a knife up the spine. At 19, he ended up with a herniated disc, excruciating pain and a long list of can’ts and don’ts. That was also the first time he heard the words: “You should not be an actor.” He proved his doctors wrong. But at 33, when he was put on crutches for six months for arthritis on his right knee, he despaired. “The pain was unbearable. There was hardly any cartilage left. That’s when fear set in and made me imagine the worst.”Click here to EnlargeHis journey captures the story of seven million Indians, who live, work and fight with debilitating pain every year. Modern medicine has conquered many diseases and halted others, but attitude towards patients in pain-even the terminally ill-has largely remained primitive. Roshan, however, is free of pain now. He happens to be a beneficiary of the new emerging science of pain. After decades of slow progress, an explosion of new research, treatments and therapeutics is changing the way pain is understood and managed. There is new hope in what scientists have learned about how pain works: That it’s not the reality of your injury or illness, pain is how unwell your brain thinks you are.advertisementClick here to EnlargeIs a pain-free future on the horizon? Roshan, for one, certainly thinks so. He has gone through cutting-edge treatments-from functional manual therapy to myofascial tissue massage-that would have been impossible even a few years ago. Now Indian scientists have come up with a new drug that can target cells at the level of molecules and stop the brain from responding ’emotionally’ to what it perceives to be damage to the body-or pain. Now waiting for global patent, it is the only reported such pain molecule in the world to have gone through clinical trials.Pain hit the headlines this year with a vengeance, as Bollywood’s glamorous stars went in and out of hospitals. Amitabh Bachchan blogged in April about his “horrendous pain” that made it difficult for him to “walk, stand, sit or lie down”. Shah Rukh Khan wrote on Facebook in January about pain in his ribs: “Hurts only when I laugh or breathe.” Salman Khan complained of “unbearable pain” in his jaws and cheeks, a recurring issue. Roshan went public about his condition after completing 85 days of “non-stop, hardcore action” for his forthcoming science fiction film, Krrish 3: “Hanging from a harness 100 feet off the ground is probably the worst thing for any spine.”Click here to EnlargeIt hasn’t quite made the headlines but the All India Institute of Medical Sciences (AIIMS) is organising lectures on pain management for MBBS students this year-the first such in India. “For years, chronic pain has been neglected by doctors,” says Dr Sushma Bhatnagar, anaesthesiologist with the cancer centre at AIIMS. “Most treat it as a symptom of other diseases and not as a disorder that should be targeted in itself for relief.” The Medical Council of India recognised it as an MD specialisation in 2011, after global NGO Human Rights Watch revealed in its report the lack of basic knowledge among Indian doctors about pain management.The God is in biology. Way back in the 1990s, when behavioural neurologist V.S. Ramachandran experimented with mirrors on a patient tortured by “phantom pain” in an amputated arm, it led to the most exciting story in all of pain science: That chronic pain has more to do with the way the brain rewires itself after mining all its data-thoughts, feelings, beliefs, expectations, memories and genetics.”It was a radical shift in opinion,” says Ramachandran, now the director of Center for Brain and Cognition at University of California, San Diego, US. “We have been urging the new view that something like chronic pain is caused by a shift in equilibrium in the brain. Often, you just need a reset button to shift it back with very simple procedures.” A decade-and-a-half of brain imaging has proved that.advertisementImagine this: You get hurt. Your cells start oozing enzymes, signalling white blood cells to come over and heal. The heat produced in the rush upsets little ‘molecular thermometers’ located on the pain receptors of your skin. They communicate electrical impulses about what is happening in your body’s environment through the spinal cord to your brain. The brain immediately sends it to various units to interpret the signal: Where does the pain came from? What is it like? How does it compare with other pain it knows? The emotional hub, the limbic system, is the final interpreter. Depending on how it decides to ‘feel’ the pain, you yell, cry, break out in sweat, or your heart starts racing. All within a fraction of a second.Click here to EnlargeWhat if there is a drug that can stop the little ‘thermometers’ from communicating with the brain? That’s exactly what a team of 60 scientists is trying to do at the sprawling Novel Chemical Entities lab of Glenmark Pharmaceuticals Ltd at Mahape in Navi Mumbai. A world of biotech is gathering momentum here since 2007 on pain therapeutics. Scientists are designing novel molecule structures and making new compounds. “The new science shows unique pain pathways,” says chief scientist Neelima Joshi. The molecule they have discovered, GRC 15300, can act on one such pathway, ‘molecular thermometer’ TRPV3, and block it from transmitting signals to the brain. “No pharma company in the world has been able to discover and develop a TRPV3 molecule and take it to clinics,” she adds. “There has been little breakthrough in pain therapeutics in the last 80-100 years,” says Glenn Saldanha, Chairman and MD of Glenmark. “Old pain-relieving options like opioids and non-steroidal anti-inflammatory drugs (NSAID) have limited impact, addiction potential and safety issues.” But the market for painkillers is going up by 16-20 per cent a year, as chronic pain-lower-back pain, arthritis and headaches top the list-keeps 30 per cent of Indians from enjoying life, according to data compiled by the Delhi Pain Clinic. Moreover, with few or no drugs available for excruciating pain linked to cancer, osteoarthritis or neuropathies, there is a large unmet need for pain as an area of treatment.So what goes wrong in chronic pain? Shouldn’t the pain stop after an injury or damage heals? “In chronic pain, the body’s alarm system breaks down,” says orthopaedic surgeon Dr Rajesh Malhotra of AIIMS. “There is no threat to the body, yet nerves continue to fire pain messages to the brain and that becomes the pattern.” But why do some patients develop chronic pain while others don’t? The answer is likely to be genetic, he says.That raises another sticky issue: Is it possible to measure pain? “Most physicians work largely in the dark,” says neurologist Dr Sumit Singh of Medanta-The Medicity in Gurgaon, “relying on patient narrative and the four vital signs: Temperature, pulse, respiration and blood pressure.” But new ways of rating pain, allowing patients to choose their pain level, are being devised: From verbal to numerical, facial expression to visual analogue scales.advertisementNew treatment approaches are pouring out of clinics and hospitals. Hip-replacement surgeries are often being substituted by a newer alternative, visco-supplementation, a relatively painless procedure where a liquid is pumped into the joint for temporary relief for arthritic pain. Skin patches that deliver painkiller drugs are also being used to treat back-neck-shoulder pain due to a sedentary lifestyle, or chronic arthritis and muscle pain. Botulinum toxin A, a wrinkle-fighter, is gaining currency as a tool for fighting headaches. Botox blocks a neurotransmitter that sends messages from brain to muscles to clench.The new approach to pain management is making seasoned hospital entrepreneurs to look for an edge in marketing healthcare in a new avatar: The pain clinic. Dr Gerd Mueller’s brand new pain boutique, ActivOrtho, in Vasant Vihar, Delhi, is one such. An orthopaedic surgeon and expert in pain and sports medicine, Mueller has been running centres in Germany. But the continuous flow of patients from India led him to the idea of creating a broader pain management clinic in Delhi.”We are bringing in the idea of European Rehabilitation focused on a multidisciplinary approach towards chronic pain,” says Mueller. That means addressing all the dimensions of a person’s life to treat pain: Structural issues (is there any problem with the spine or bones?); functional (are the muscles in order?), social (what sort of lifestyle and social support does the patient have?) and psychological (is the patient suffering from anxiety and depression?).Clinics like Mueller’s show how quickly pain treatment is changing. As a student in the 1970s, Dr Rajesh Malhotra remembers how little was understood about the processes behind pain. “Most of the neurotransmitters were not known,” he says. Can pain be conquered? “I certainly think so,” he says with infectious optimism.Roshan still gives himself an hour a day to stay out of pain, but that old fear of mortality is gone. He can play with his children, act and lead an active life again. And he certainly does not have to say goodbye to dance or to his movies. “If I believed what was told to me by my doctors, I would have given up very early in life,” he says. “But I’ve always believed that nothing is impossible. And here I am.”-With Shilpa Mehta.
WILMINGTON, MA — Below is a round-up of what’s going on in Wilmington on Monday, October 8, 2018:Happening Today:Weather: Cloudy, with a high near 59. Light northeast wind.Happy Columbus Day! Town offices, schools, library, and senior center are closed today, as are banks and the post office. Retail stores are open at the owner’s discretion. Market Basket and Lucci’s are open.Trash & Recycling Delayed: Wilmington’s residential trash and recycling collection will be delayed this week by one day due to the holiday.On WCTV: Watch WCTV’s latest content that debuted last week HERE.Go Wildcats!: SIX WHS teams are in action today, including the Boys Varsity Soccer team hosting Lexington at 10am at the North and the Girls Varsity Soccer team traveling to Lexington at 10am at Lincoln Park. [See the full schedule HERE.](NOTE: What did I miss? Let me know by commenting below, commenting on the Facebook page, or emailing firstname.lastname@example.org. I may be able to update this post.)Like Wilmington Apple on Facebook. Follow Wilmington Apple on Twitter. Follow Wilmington Apple on Instagram. Subscribe to Wilmington Apple’s daily email newsletter HERE. Got a comment, question, photo, press release, or news tip? Email email@example.com.Share this:TwitterFacebookLike this:Like Loading… RelatedThe Wilmington Insider For October 9, 2017In “5 Things To Do Today”The Wilmington Insider For February 19, 2018In “5 Things To Do Today”The Wilmington Insider For October 17, 2018In “5 Things To Do Today”
.Unnayan Onneshan (UO), an independent multidisciplinary think-tank, has said the proposed budget for 2018-19 fiscal year lacks measures necessary to address the macroeconomic, medium term and institutional challenges the economy is facing.”The budget speech seems to lack providing prudent and farsighted solutions to the current challenges except it earmarks ambitious targets of expenditure amidst inefficient distribution of resources and cost overrun,” it said its rapid assessment of the new proposed national budget.Inequality has widened on the back of the gap between return on capital and return on labour on the one hand and the persistent primitive accumulation in the form of looting in different sectors of the economy on the other, the think-tank said.Institutional fragility has been evident in the economy, leading different economic sectors to fail to maintain discipline, it said, adding that institutional fragility and political uncertainty are contributing to lack of confidence among investors and entrepreneurs.The UO said in the wake of parliamentary elections, investors may adopt wait-and-see policy about making investment since they are fearful about the process of the transition of power and the subsequent business environment recalling the situation after the national election back in 2014.It said incapacity to implement the budget has been a major challenge in recent years. The rate of implementation has assumed a decreasing trend since FY 2011-12. In FY 2011-12, budget implementation rate was 93 per cent which decreased to 91 per cent in FY 2012-13, 85 per cent in FY 2013-14, 82 per cent in FY 2014-15, 81 per cent in FY 2015-16 and 79 per cent in FY 2016-17.Despite the increasing trend in tax revenue over the years, the tax-GDP ratio is very low compared to global average. In FY 2015-16, Tax-GDP ratio in Bangladesh stood at 8.98 per cent, while it increased slightly to 9 percent and 10.39 per cent in FY 2016-17 and FY 2017-18 respectively.Bangladesh has a regressive tax structure where people with low income have to share relatively larger share of the tax burden due to different forms of indirect taxes. In 2018-19 budget, revenue from income tax and VAT has been estimated to be Tk 1,007.19 billion and Tk 1,105.55 billion respectively. In FY 2018-19, 34 per cent of total NBR revenue would come from taxes on income and profit whereas 53.79 per cent would come from indirect sources, including Value Added Tax and Supplementary Duty, together.The budget has set a target of collecting Tk 3,392.80 billion as revenue receipts. The target seems to fall short since a gap between revenue target and actual collection has been regular, the think-tank said.In the first nine months of the current fiscal year, the revenue collection stood at Tk 1,440 billion against a target of Tk 1,670 billion leaving a shortfall by Tk 230 billion.About the rising operating expenditure, the UO evinces that in the budget for FY 2018-19, a total of Tk 1122.66 billion has been proposed for salary and allowances and interest repayment which constitutes 24.17 per cent of the total budgetary outlay. In addition, in the proposed budget for FY 2018-19, operating expenditure grows by 21 per cent while development expenditure registers a 13 per cent growth.It mentioned that it has been regular phenomenon in Bangladesh that the mass people fear national budget. This is because budget has been the occasion of increase in price of many necessities either directly or indirectly.The measures taken in the budget 2018-19 is likely to increase price of some 19 commodities while reducing price of some 14 commodities.While national budget is directly linked to the living standard of the mass, they have little stake in the formulation of budget. Lack of fiscal accountability in Bangladesh due to limited role of the parliament in budget-making process together with constitutional and systematic rigidities results in inefficiency, poor implementation of budget and misuse of public resources, the think-tank said.It said due to persistent depreciation, the local currency has been exposed to serious pressure. In 2017, local currency has experienced a depreciation of 5 percent against US Dollar. In May 2018, the exchange rate has stood at Tk 83.70 per USD which was Tk 80.69 in August 2017. Depreciation of local currency has added to the inflationary pressure on the mass.Sluggish export growth and cut in the inflow of wage earners’ remittance along with high import payment is exerting pressure on the current account balance. Referring to the deficit in current account balance, the think tank finds that the current account balance recorded a deficit of USD 7.08 billion during July-March, 2017-18 due mainly to a significant trade deficit and lower income from services and primary income accounts compared to that of July-March, 2016-17.High inflationary pressure is increasing the cost of living, thus gradually degrading the living standard of the mass by lowering the consumption capacity of the people with limited income. Statistics suggest that twelve-month average inflation increased to 5.83 per cent in April 2018 from 5.82 per cent in March 2018.Observing institutional fragility in the banking sector due to massive irregularities followed by rise in default loans and resulting capital shortfall, the UO shows that at the end of 2017, total default loans in the banking sector stood at Tk 743.03 billion, representing 9.31 per cent of the gross loan, compared to Tk 621.72 billion in the previous year.Amid chaotic situation in the country’s financial sector and political uncertainty ahead of the national election, foreign investors are increasingly making exit from capital market, the UO said.Private sector investment has been remaining stagnant at below 23 per cent for a decade. It stood at 22.07 per cent of GDP in FY 2014-15, 21.78 per cent in FY 2015-16, 23.1 in FY 2016-17 and 23.25 per cent in FY 2017-18.Meanwhile, it is found that net Foreign Direct Investment (FDI) has slumped recently. In 2017, FDI has declined by 7.76 per cent compared to that in the previous yearThe economy of Bangladesh is missing the opportunity to capitalise its demographic dividend. While the GDP growth figure is impressive, the poor rate of quality job creation is characterising it as jobless growth. The economy is presenting disconcerting job scenario with a huge number of people remaining out of work.Referring to the state of jobless growth, the research organisation notes that unemployed population increased to 2.68 million in FY 2016-17 while 1.46 million remained underemployed. In addition, the number of people not in education, employment or training rose to 48.28 million in FY 2016-17, representing 44.25 per cent of the people who are able and ready to work, from 46.6 million in FY 2015-16.If not dealt with effectively, income inequality together with inequality in access to health and social security, multidimensional poverty, and joblessness particularly among the youth may undermine the development already achieved by the county, comments the UO.Calling for prudent and farsighted fiscal management, the research organisation states that proposed actions are inadequate to bring fiscal discipline in the management of revenue, deficit and debt one the one hand and to establish an inclusive society in the absence of distributive reforms in the tax system on the other.
Emergency personnel attend to victims of a stampede at a nightclub in Corinaldo, near Ancona, Italy, in this undated handout picture. Photo: ReutersSix people have died in a stampede at an Italian nightclub near Ancona on the Adriatic coast after panic erupted, firefighters said Saturday.“The cause may have been the dispersal of a stinging substance, the young people fled and trampled over each over. Sadly, six people died and dozens are injured,” the fire service said in a statement on Twitter.