Category Archives: Pain Research

Cannabinoid Drugs May Slightly Increase Pain Threshold

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MedicalResearch.com Interview with:
“Cannabis” by Don Goofy is licensed under CC BY 2.0Martin De Vita, MS
Doctoral Candidate
Clinical Psychology Department
Syracuse University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Despite widely held beliefs that cannabis is effective for pain relief, experimental trials have produced mixed results. As result, the analgesic properties of cannabinoid drugs have remained poorly understood. We aimed to clarify these findings by extracting data from every available experimental pain study and analyzing the results as a whole. We found that numerous aspects of pain were being influenced in different ways. We found that cannabinoid drugs did not significantly reduce the intensity of experimental pain, but they did produce small-sized reductions in pain unpleasantness. Cannabinoids produced significant analgesic effects on pain threshold and tolerance. There was no significant effect of cannabinoids on mechanical hyperalgesia. Continue reading →

Patient-Reported Symptom Relief Following Medical Cannabis Consumption

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MedicalResearch.com Interview with:

Jacob M. Vigil, PhD
Department of Psychology
University of New Mexico

MedicalResearch.com: What is the background for this study?

 

Response: For the past several years we have been using observational research designs as a means to overcome some of the logistical and legal barriers for conducting patient outcomes medical cannabis research. In partnership with the software developers of the Releaf App which currently is the largest repository of user-entered information on the consumption and effects of cannabis use in the United States, we have been able to measure how patients choose to consume cannabis and the effects of those choices in real-time.  Since its release in 2016, the commercially developed Releaf App has been the only publicly available, incentive-free patient educational software program designed for recording how individual cannabis usage sessions correspond to immediate changes in symptom intensity levels and experienced side effects.

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Invasive Procedures For Chronic Pain Have Not Been Proven to Work

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MedicalResearch.com Interview with:

Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine

Dr. Jonas

Wayne B. Jonas, MD
Clinical Professor of Family Medicine
Uniformed Services University and at
Georgetown University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

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Surgeons Likely Overprescribing Opioids After Rhinoplasty

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MedicalResearch.com Interview with:

David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School 

Dr. Shaye

David A. Shaye, M.D., FACS
Instructor in Otolaryngology
Harvard Medical School 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids.

In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons.

Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills.

We believe patients experienced less pain than surgeons anticipated.

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Mobile Devices Support Clinical Trials of Chronic Musculoskeletal Pain

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MedicalResearch.com Interview with:

Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento

Dr. Kravitz

Richard L Kravitz, MD, MSPH
Professor, General Internal Medicine
Director, UC Center Sacramento

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response:  The study was designed to address tso problems. The first is that many patients with chronic pain struggling to find a workable regimen.

The second is more general. Patient sometimes I hesitate to participate in clinical research because they right away do not see the relevance I directly to them selves. And have one trials are away I’m addressing both problems.  Continue reading →

ORILISSA™ (elagolix) Now Approved for Management of Moderate to Severe Pain Associated with Endometriosis

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MedicalResearch.com Interview with:

Dr. Dawn Carlson MD MPH Vice President, General Medicine Development AbbVie 

Dr. Carlson

Dr. Dawn Carlson MD MPH
Vice President, General Medicine Development
AbbVie 

MedicalResearch.com: Please provide some background on this announcement. Would you briefly explain what endometriosis is? Whom does it affect and how does it interfere with quality of life?

Response: Endometriosis is one of the most common gynecologic disorders in the U.S that affects an estimated one in 10 women of reproductive age. It occurs when tissue similar to the lining of the uterus starts growing outside of the uterus, where it doesn’t belong.

The symptoms of endometriosis, including pain with menstrual periods and between periods, and with sexual intercourse, can be debilitating and significantly impact day-to-day activities of women’s lives, personally and professionally. Unfortunately, women with endometriosis can suffer for up to 10 years and visit multiple physicians before receiving a proper diagnosis. Unresolved endometriosis pain results in higher healthcare costs from emergency department visits and repeat surgeries.  Continue reading →

Ketamine vs Opioids for Acute Pain in the Emergency Department

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MedicalResearch.com Interview with:

Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine

Dr. Schwarz

Evan Schwarz, MD FACEP, FACMT
Associate Professor of Emergency Medicine
Medical Toxicology Fellowship Director
Section Chief Medical Toxicology
Advisory Dean in the Office of Student Affairs
Division of Emergency Medicine
Washington University School of Medicine 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department.

Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED.

In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.

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Migraine Management Crucial For Treatment of Tinnitus

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MedicalResearch.com Interview with:
“Day 50: Headache” by kizzzbeth is licensed under CC BY 2.0Jen-Tsung Lai, MD
Department of Otolaryngology
Kuang-Tien General Hospital
Shalu, Taichung, Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cochlear Migraine( CM ) is a new proposed diagnosis in 2018. CM could present as fluctuating hearing loss or sudden hearing loss that provoked the tinnitus.

Furthermore , CM with underlying hypersensitive brain might cause the tinnitus switch out of function.  

MedicalResearch.com: What should readers take away from your report? 

Response: Cochlear Migraine (could be one of the key code for chronic tinnitus. Similar to vestibular migraine (VM ) in vertigo diagnosis, Cochlear Migraine is a very important cause of tinnitus and heating loss.

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: The clinical implication : the migraine management is crucial for tinnitus treatment. 

Citation:

Hwang J, Tsai S, Liu T, Chen Y, Lai J. Association of Tinnitus and Other Cochlear Disorders With a History of Migraines. JAMA Otolaryngol Head Neck Surg. Published online July 12, 2018. doi:10.1001/jamaoto.2018.0939

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Acupuncture For Pain in Breast Cancer Patients on Aromatase Inhibitors

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MedicalResearch.com Interview with:

Dawn Hershman, MD, MS, FASCO Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center

Dr. Hershman

Dawn Hershman, MD, MS, FASCO
Professor of Medicine and Epidemiology
Leader, Breast Cancer Program
Herbert Irving Comprehensive Cancer Center
Columbia University Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Aromatase inhibitors are effective in reducing the risk of recurrence in hormone sensitive breast cancer, however they commonly cause joint pain and stiffness that can lead to early discontinuation of treatment. We know that women who stop early do not get the same benefits as those who continue for the full duration.

Acupuncture has been shown to improve a variety of pain syndromes. We conducted a large multicenter trial among women with joint pain on aromatase inhibitors and randomized patients to true acupuncture, sham acupuncture and a waitlist control arm.

We found that acupuncture resulted in more pain reduction than the other 2 control groups. Measuring pain can be challenging in clinical trials. We now know that a meaningful reduction for a patient is 2 points on a 10 point scale. We found that nearly 60 percent of women in the true acupuncture group experienced at least a 2-point reduction in pain, versus 33 percent of the sham acupuncture group and 31 percent of the controls. These results where highly statistically significant.  Continue reading →

More Weight Loss Linked To Greater Decrease in Knee Arthritis Pain

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MedicalResearch.com Interview with:

Wake Forest professor of Health and Exercise Science Steve Messier, Friday, June 15, 2018.

Prof. Messier

Professor Steve Messier
Director of the J.B. Snow Biomechanics Laboratory
J.B Snow Biomechanics Laboratory
Wake Forest University

MedicalResearch.com: Why did you undertake this study?

Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273.

We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial.

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Gabapentin and Pregabalin Should Be Used Cautiously in Hemodialysis Patients

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MedicalResearch.com Interview with:

Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center

Dr. Ishida

Dr. Julie H. Ishida MD
Department of Medicine, Division of Nephrology
University of California, San Francisco and
San Francisco Veterans Affairs Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population.

Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population.  Continue reading →

Zosano Developing Dermal Patch to Quickly Relieve Migraine Pain

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MedicalResearch.com Interview with:
Zosano Pharma
Dr. Peter Schmidt, MD, MSc
Senior Director, medical Affairs and Clinical Development
Zosano Pharma

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a post-hoc analysis of Zosano’s pivotal efficacy trial using its adhesive dermally-applied microarray (ADAM) zolmitriptan formulation, M207. The trial found that M207 was effective versus placebo for the co-primary endpoints of pain freedom and most bothersome symptom (MBS) freedom, both at two hours. The MBS endpoint was just ratified as a new endpoint in the FDA’s February 2018 guidance for acute migraine trials. The stated aim of this new endpoint is “…to better align the study outcome with the symptom(s) of primary importance to patients…” This is logical, as a given migraine patient may not experience all four previous symptom endpoints (pain, photophobia, phonophobia, nausea). Continue reading →

Cigna Creates Online Initiative To Drive Patient-Provider Conversations Regarding Pain and Opioid Prescriptions

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MedicalResearch.com Interview with:

Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna

Dr. Lustig

Dr. Stuart Lustig, M.D., M.P.H
National Medical Executive for Behavioral Health
Cigna

Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic.

MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study?

Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention.

The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.

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Does Chiropractic Care Benefit Low Back Pain?

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MedicalResearch.com Interview with:
“Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD
Vice Chancellor for Research and Health Policy
Palmer College of Chiropractic

MedicalResearch.com: What is the background for this study?

Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel.

Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military.

Continue reading →

Ibuprofen Can Not Replace Antibiotics in Uncomplicated UTI

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MedicalResearch.com Interview with:

Ingvild Vik MD Doctoral Research Fellow Department of General Practice Institute of Health and Society - UiO University of Oslo, Norway.

Dr. Vik

Ingvild Vik MD
Doctoral Research Fellow
Department of General Practice
Institute of Health and Society – UiO
University of Oslo, Norway

MedicalResearch.com: What is the background for this study?

Response: Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. It is painful and troublesome, and even though it is often self-limiting most women who see a doctor will be prescribed an antibiotic, as antibiotics provide quick symptom relief.  Antibiotic resistance is a growing, serious public health problem. Antibiotic use is the main contributor to antibiotic resistance, and to stop the rapid development it is crucial that we reduce unnecessary use of antibiotics. Antibiotics can cause unpleasant and potentially severe side effects, so avoiding unnecessary use is also beneficial for the individual patient.

A small German trial published in 2010 by Bleidorn et al. suggested that ibuprofen was non-inferior to the antibiotic ciprofloxacin in achieving symptomatic cure in uncomplicated UTI. This inspired us to conduct a larger trial to compare the anti-inflammatory drug ibuprofen to antibiotics in the treatment of uncomplicated UTI.  Continue reading →

Sciatica: Biomarker Demonstrates Inflammation, Not Just Compression of Nerve Roots

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MedicalResearch.com Interview with:

“osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD
Research Fellow in Radiology, Harvard Medical School
Research Fellow, Massachusetts General Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury.

This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited.

In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots.

Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation.

While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain.  Continue reading →

Not All In Your Head: Psychological Therapies Not a Panacea for Pain

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MedicalResearch.com Interview with:

Dr. M. Carrington Reid, MD PhD Associate Professor of Medicine Irving Sherwood Wright Associate Professor in Geriatrics Joachim Silbermann Family Clinical Scholar in Geriatric Palliative Care Joan and Sanford I. Weill Department of Medicine Weill Cornell Medical College 

Dr. Reid

Dr. M. Carrington Reid, MD PhD
Associate Professor of Medicine
Irving Sherwood Wright Associate Professor in Geriatrics
Joachim Silbermann Family Clinical Scholar
Geriatric Palliative Care
Joan and Sanford I. Weill Department of Medicine
Weill Cornell Medical College

MedicalResearch.com: What is the background for this study?

 

Response: Major guidelines (American College of Physicians, Centers for Disease Control, Veterans Administration) on the management of chronic pain strongly encourage clinicians to use nonpharmacologic approaches to include psychological therapies when managing pain.

While many studies have evaluated psychological therapies such as cognitive behavioral theraphy (CBT) in nonelderly populations with chronic pain, far fewer have evaluated these treatments in studies of older adults. We identified 22 randomized controlled trials that evaluated a psychological therapy for chronic pain in older adults and examined the impact of these treatments on salient outcomes to include ability to reduce pain and pain-related disability, improve patients’ self efficacy to manage pain, and improve their physical health and function and their psychological health (by reducing rates of anxiety and depression).

Continue reading →

Women and Uninsured More Likely to Suffer from Migraines

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MedicalResearch.com Interview with:

Paul B. Rizzoli, M.D., FAAN, FAHS Department of Neurology Brigham and Women’s Hospital Clinical and Fellowship Director, John R Graham Headache Center Brigham and Women’s Faulkner Hospital Assistant Professor of Neurology Harvard Medical School

Dr. Rizzoli

Paul B. Rizzoli, M.D., FAAN, FAHS
Department of Neurology
Brigham and Women’s Hospital
Clinical and Fellowship Director, John R Graham Headache Center
Brigham and Women’s Faulkner Hospital
Assistant Professor of Neurology
Harvard Medical School

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Migraine and other recurrent headache disorders disproportionately affect otherwise healthy, middle-aged people, particularly women, and are a leading cause of suffering and disability.

Accurate epidemiologic information is vital for providers, researchers and policy makers. In this paper we surveyed the most recent data from population-based studies in the United States to assess the burden and impact of these conditions. Our search included such sources as the National Health Interview Study (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS).

We found that the prevalence and burden of self-reported migraine and other severe headache has remained stable but high in the past 19 years, affecting roughly 1 out of every 6 Americans (15.3%) and 1 in 5 women (20.7%) over a 3-month period.

Among other findings was that headache is proportionately more burdensome those in middle age (elderly also), those who are unemployed and those who are disabled or who have low family income. Headache represents roughly 3% of all annual emergency department visits.  Continue reading →

Are Opioids Effective for Dental Pain?

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MedicalResearch.com Interview with:
“Dental Exam” by 807th Medical Command (Deployment Support) is licensed under CC BY 2.0Paul A. Moore, DMD, PhD, MPH
School of Dental Medicine
University of Pittsburgh 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of our study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews.

We found combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations.

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Which NSAID for Knee Pain Works Best?

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MedicalResearch.com Interview with:
“dog” by Neil Mullins is licensed under CC BY 2.0Deborah S. Cummins, PhD
Director, Research, Quality and Scientific Affairs
American Academy of Orthopaedic Surgeons
On behalf of the researchers:
David Jevsevar, MD, MBA; Gregory A. Brown, MD, PHD, and Deborah S. Cummins, PhD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is estimated that individuals have a 45% risk of developing knee osteoarthritis (OA) in their lifetime. As a result of the shifting demographics of the US, where an increasing percentage of the population is older than 65, the burden of knee OA will continue to increase. To help deal with this burden, effective nonsurgical treatments are needed to manage knee OA symptoms associated with pain and function before surgical intervention becomes necessary. To determine which non-surgical options are best, we performed a network meta-analysis exploring mixed treatment comparisons for nonsurgical treatment of knee osteoarthritis in order to effectively rank the various nonsurgical treatment options from best to worst.

Our network meta-analysis suggests that the single most effective nonsurgical treatment for improving knee function is function is naproxen, followed by diclofenac, celecoxib, and ibuprofen. When considering pain and function together, our data suggest that naproxen is the most effective treatment followed by IA corticosteroid injection.

The single most effective short-term (4-6 weeks) treatment for decreasing pain is intra-articular (IA) corticosteroid injection, followed by ibuprofen, IA platelet rich plasma, and naproxen. Additionally, intra-articular hyaluronic acid injections never achieved a rank in the top five treatments for pain, function, or combined pain and function. An analysis of 12 articles also found that HA is not significantly different than IA placebo in effect.

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More Than Half of Surveyed Chronic Pain Patients Report Opioid-Induced Constipation

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MedicalResearch.com Interview with:

Dr. Joseph Pergolizzi MD Senior Partner and Director of Research Naples Anesthesia and Pain Associates Naples, Florida Adjunct Assistant Professor Johns Hopkins University School of Medicine Baltimore, Maryland

Dr. Pergolizzi

Dr. Joseph Pergolizzi MD
Senior Partner and Director of Research
Naples Anesthesia and Pain Associates
Naples, Florida

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: There are roughly 100 million Americans living with chronic pain and many battle debilitating side effects because of their pain medication, including Painstipation otherwise known as opioid-induced constipation (OIC.) In fact, OIC is the most common side effect with approximately 40-80 percent of patients on chronic opioid therapy experiencing it.

To better understand this community, the Painstipation survey, conducted by Salix Pharmaceuticals in partnership with the U.S. Pain Foundation, surveyed 441 U.S. adults with chronic pain who were on opioid therapy and suffering from OIC. It gave great insight into this community as it found:

  • More than half (51 percent) of chronic pain patients have been suffering from opioid-induced constipation  for three years or longer
  • Most patients (73 percent) agree that one of the biggest challenges of having OIC is that medications don’t work quickly enough to relieve pain associated with OIC.
  • 53 percent of patients say they want relief for OIC in under four hours
  • Only half of patients surveyed (73 percent) surveyed said they were informed by their doctors that taking opioid medications might result in constipation before they began taking them
  • 77 percent of respondents reported suffering from OIC for at least one year
  • When asked, roughly one-third (32 percent) of patients reported that their doctor does not talk to them specifically about potential adverse drug-to-drug interactions (DDI) of their current prescription and/or over-the-counter medications.

Continue reading →

Migraine Linked To Increased Risk of Heart Disease and Stroke

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MedicalResearch.com Interview with:

Islam Elgendy MD Division of Cardiovascular Medicine University of Florida  

Dr. Elgendy

Islam Elgendy MD
Division of Cardiovascular Medicine
University of Florida  

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Migraine headache is a prevalent medical condition, often being chronic and debilitating to many. Previous studies have shown that migraine, particularly migraine with aura, is associated with an increased risk of cardiovascular events. Recently, a number of these studies have reported long-term follow up data. To better understand the long-term morbidity that is associated with migraines, we performed a systematic evaluation to study the link between migraine and risk of cardiovascular and cerebrovascular events.

This study demonstrated that migraine is associated with an increased risk of major adverse cardiovascular and cerebrovascular events, which was driven by an increased long-term risk of myocardial infarction and stroke. This effect was predominantly observed in migraineurs who have aura.  Continue reading →

Tai Chi At Least As Beneficial As Standard Therapy For Fibromyalgia

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MedicalResearch.com Interview with:
“tai chi 11.4.09” by Luigi Scorcia is licensed under CC BY 2.0Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
Director, Center For Complementary And Integrative Medicine
Division of Rheumatology
Tufts Medical Center Boston, MA 02111 

MedicalResearch.com: What is the background for this study?

Response: Patients with chronic widespread pain often try many different types of pain medications, anti-depressants, physical therapy, and other approaches, and commonly find that none of these therapies work for them. Finding safe, effective approaches for pain management is an urgent priority. Previous evidence suggested that Tai Chi, a multi-dimensional mind-body practice that integrates physical, psychosocial, and behavioral elements, may be especially suited to address both chronic pain and associated psychological and somatic symptoms. In our most recent study published in the BMJ, we directly compared the effectiveness of Tai Chi versus aerobic exercise, which is a standard care non-drug treatment for fibromyalgia. Continue reading →

Hand Osteoarthritis: Hydroxychloroquine No More Effective Than Placebo

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MedicalResearch.com Interview with:
Dr Sarah Kingsbury PhD
Osteoarthritis Strategic Lead
Deputy Section Head, Musculoskeletal Medicine and Imaging
Leeds Institute of Rheumatic and Musculoskeletal Medicine
University of Leeds

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Osteoarthritis of the hand is a painful and disabling condition, estimated to effect up to 31 per cent of people aged over 70. It can stop people from carrying out everyday activities and can limit their quality of life. The first-line pharmacological treatments for hand osteoarthritis, including paracetamol and non-steroidal anti-inflammatory drugs, are often not effective and are associated with side effects. Doctors have used hydroxychloroquine, an established treatment for rheumatoid arthritis, as an off-label alternative, supported by increasing evidence that inflammation is a factor in osteoarthritis. Until now, there has not been a large-scale study into whether using hydroxychloroquine works.

HERO was a 12 month randomised, double-blind, placebo controlled, pragmatic trial, designed with a view to replicate anecdotal reports of hydroxychloroquine use in clinical practice, and  powered to detect a moderate effect equivalent to that for NSAIDs in this population. The study involved 248 patients at 13 NHS hospitals in England: all had the condition for at least 5 years, had changes to the joints in their hands consistent with osteoarthritis and reported moderate to severe pain on at least half of the days in the previous three months to the study commencing.

Participants were randomised 1:1 to either hydroxychloroquine or placebo and followed up at 3 monthly intervals for 12 months. The study found that patients initially reported a small reduction in the severity of pain before the improvement plateaued. However, a similar amount of change was seen in both the group receiving hydroxychloroquine medication and the group taking the placebo.

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Migraine Linked To Increased Risk of Stroke, AFib, PE and Cardiovascular Disease

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MedicalResearch.com Interview with:
“Headache.” by Avenue G is licensed under CC BY 2.0Kasper Adelborg, MD, PhD
Postdoctoral Fellow
Department of Clinical Epidemiology
Aarhus University Hospital 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Around one billion people worldwide are affected by migraine. Migraine has considerable impact on quality of life and imposes a substantial burden on society. Migraine is primarily a headache disorder, but previous studies have suggested a link between migraine and stroke and myocardial infarction, particularly among women, while the link between migraine and other heart problems are less well known.

In this large register-based Danish study published in the BMJ, we confirmed that migraine is associated with increased risks of stroke and myocardial infarction, but we also found that migraine was associated with increased risks of other cardiovascular diseases (specifically, venous thromboembolism and atrial fibrillation). Migraine was not associated with increased risks of heart failure or peripheral artery disease.

In contrast to most previous studies, our study had a very large sample size and an age- and sex- matched comparison cohort from the general population, which allowed us to put migraine in a population context and to perform several subgroup analyses. Here, we found several interesting findings.

  • In general, the associations were strongest in the first year after diagnosis but persisted in the long term (up to 19 years after diagnosis).
  • Most associations applied to both migraine patients with aura (warning signs before a migraine, such as seeing flashing lights) and in those without aura, and in both women and in men. 

Continue reading →