Post-Surgical Medications Are Major Cause Of New Chronic Opioid Use

MedicalResearch.com Interview with:

Chad M. Brummett, M.D. Associate Professor Director, Clinical Anesthesia Research Director, Pain Research Department of Anesthesiology Division of Pain Medicine University of Michigan Medical School Ann Arbor, MI  48109

Dr. Brummett

Chad M. Brummett, M.D.
Associate Professor
Director, Clinical Anesthesia Research
Director, Pain Research
Department of Anesthesiology
Division of Pain Medicine
University of Michigan Medical School
Ann Arbor, MI  48109 

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

Response: The opioid epidemic has received tremendous attention in recent years, but most of the focus has been on chronic pain, opioid abuse and overdose. Far less attention has been paid to the importance of acute care prescribing (e.g. surgical pain) in patients that are not chronic opioid users.

We found that 5-6% of patients not using opioids prior to surgery continued to fill prescriptions for opioids long after what would be considered normal surgical recovery. Moreover, the rates of new chronic use did not differ between patients having major and minor surgeries, suggesting that patients continue to use these pain medications for something other than simply pain from surgery. Building on other work by our group, and the few additional studies done on the topic to date, these data suggest that pain medications written for surgery are a major cause of new chronic opioid use for millions of Americans each year.

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Statins Users May Have Higher Likelihood of Back Disorders

MedicalResearch.com Interview with:

Una Makris MD, MSc Clinical Investigator at the VA North Texas Health System Assistant Professor at UT Southwestern Medical Center Departments on Internal Medicine and Clinical Sciences

Dr. Makris

Una Makris MD, MSc
Clinical Investigator at the VA North Texas Health System
VA North Texas Health Care System
Assistant Professor at UT Southwestern Medical Center
Departments on Internal Medicine and Clinical Sciences
Dr. Makris is a Rheumatologist, clinically, and spends the majority of time focused on clinical research investigating how to improve outcomes for adults with back pain.

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

Response: Back pain is the most common type of musculoskeletal (MSK) pain. We know that expenditures for back pain exceed $100 billion each year (and this was in 2005). Back pain results in tremendous disability (including reduced mobility) and impaired quality of life (not exclusive to physical consequences, but also including important psychosocial repercussions). We also know that statins are prescribed very often, and frequently in younger populations who are active. Some reports suggest that statins may have a protective effect on  musculoskeletal conditions such as back pain.

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Modest Effect of Spinal Manipulation For Back Pain

MedicalResearch.com Interview with:

Paul Shekelle, MD PhD MPH Chief of General internal Medicine VA Greater Los Angeles Healthcare System

Dr. Shekelle

Paul Shekelle, MD PhD MPH
Chief of General internal Medicine
VA Greater Los Angeles Healthcare System

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

Response: Back pain is one of the commonest symptoms for adult patients to seek health care. For a number of years now, VA has had chiropractic care integrated into the ambulatory care available at many large VA medical centers. Most patients referred from VA primary care to chiropractic clinic have chronic back pain. VA was interested in an evidence synthesis of the use of spinal manipulative therapy in acute low back pain. Spinal manipulative therapy is a manual technique delivered by almost all chiropractors, but also delivered by some physical therapists, osteopathic physicians, and some medical doctors.

The main findings are that spinal manipulative therapy is associated with, on average, a modest beneficial effect on pain and function. However, there are large difference sin outcome across studies, and this suggests that some patients may respond much better, and other may respond not at all.

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The Opioid Epidemic and Orthopaedic Pain Management

MedicalResearch.com Interview with:

Dr. Hammoud

Dr. Sommer Hammoud

Dr. Sommer Hammoud MD
ABOS Board Certified Assistant Professor of Orthopedic Surgery
Thomas Jefferson University 

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

Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients.

Our main findings for each of those aims are the following:

1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic
2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and
3) Future research needs to focus on the psychologic aspect of patients’ ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain.

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Long-Term Opioid Use Increases With Each Additional Day On Opioid Therapy

MedicalResearch.com Interview with:
Anuj Shah (B.Pharm)

Doctoral Student
Division of Pharmaceutical Evaluation and Policy
University of Arkansas for Medical Sciences

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

Response: The CDC guideline on opioid prescribing, published in March 2016, included recommendations for initiation of opioid therapy. The guideline noted that there is a lack of data describing how acute opioid use transitions to long-term opioid use. This report seeks to address this gap by determining characteristics of initial opioid prescribing prognostic of long-term use, among opioid naïve cancer-free adults.
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Migraine Associated With Cervical Artery Dissection In Some Young Adults

MedicalResearch.com Interview with:
Alessandro Pezzini, MD, FESO

Professore Associato di Neurologia
Dipartimento di Scienze Cliniche e Sperimentali
Clinica Neurologica
Università degli Studi di Brescia
Italia

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

Response: Scarce reports have suggested that a relation might exist between migraine and cervical artery dissection (CEAD), the most frequent cause of ischemic stroke in young adults in Western countries. However, data available so far were obtained from few studies conducted on small cohorts of patients, which limits the generalizability of their findings.

In our study we analysed the data from the Italian Project on Stroke in Young Adults (IPSYS) project, one of the largest registries of young ischemic stroke patients, and observed that migraine, especially the subtype without aura was strongly and independently associated to CEAD. This seems particularly true for men and for people younger than 39 years.

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Cedars-Sinai Study Will Address How Doctors Communicate With Patients About Chronic Pain

MedicalResearch.com Interview with:
Michelle S. Keller, MPH, PhD Candidate

Health Policy and Management
Cedars-Sinai
Los Angeles CA 90048

MedicalResearch.com: What is the background for this new funding award?

Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment.

Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care.

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Leaky Gate Model Connects Intense Itch With Pain

MedicalResearch.com Interview with:

Xinzhong Dong PhD The Solomon H. Snyder Department of Neuroscience and Center for Sensory Biology Howard Hughes Medical Institute Johns Hopkins University School of Medicine Baltimore, MD 21205

Dr. Xinzhong Dong

Xinzhong Dong PhD
The Solomon H. Snyder Department of Neuroscience and Center for Sensory Biology
Howard Hughes Medical Institute
Johns Hopkins University School of Medicine
Baltimore, MD 21205

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

Response: It is a puzzle that troubles the field for many years that how pain and itch, two closely related sensations (once thought as one sensation), are differentiated by the nervous systems. Coding of pain and itch are heatedly debated for decades. The current specificity theory suggests that these two kinds of signals are carried by separate pathways, with some interactions, for example pain can inhibit itch and that explains why we all scratch to inhibit pain. It is true in the periphery (our previous study indicate a small population of neurons in the periphery only codes for itch sensation), but now our study suggests that there could be more crosstalk between these two sensations in the central than we expected.

People might not notice in real life, but in human psychophysical studies, well-isolated experimental environments, when human subjects are given itchy substances, they typically report intense itch sensations accompanied by minor noxious sensations, such as pricking, stinging and burning. Our new leaky gate model suggest in certain circumstances intense itch signals can trigger minor pain sensations, which can explain such phenomenon.

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Tele-Rehabilitation Can Improve Physical Function In Chronic Knee Pain Patients

MedicalResearch.com Interview with:
Rachel Nelligan, BPhysio
Physiotherapist & Research Physiotherapist
Department of Physiotherapy | Centre for Health, Exercise and Sports Medicine
The University of Melbourne
Victoria Australia

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

Response: This novel study investigated the efficacy of an internet delivered model of service delivery that combined online education, Skype delivered exercise physiotherapy and an Internet-based interactive pain coping skills training program for people with persistent knee pain.

Osteoarthritis, the leading cause of chronic knee pain and disability globally, has a significant individual, societal and economic burden. On an individual level knee osteoarthritis causes loss of function, reduced quality of life, and psychological distress. Clinical guidelines recommend adoption of a biopsychosocial approach to management which should include nondrug, nonsurgical treatments. Specifically exercise, education and psychological interventions (including pain coping skills training (PCST)) that foster self-management are recommended. Evidence identifies that many knee OA sufferers are not receiving adequate management due in part to challenges of accessing these effective treatments. There is an urgent need for new models of health service delivery to rectify this.

Tele-rehabilitation is growing in acceptance as an effective, time efficient and convenient means for people to access effective health interventions. In knee OA internet delivered interventions specifically remotely delivered physiotherapy exercise using specialised tele-rehabilitation equipment and an Internet-based interactive PCST program (PainCOACH), designed to translate key therapeutic elements of clinician-delivered face-to-face PCST, have shown improved patient outcomes. Prior to this study the combination of these two internet-based treatments has not been investigated.

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Stress Reduction and Cognitive Therapy Have Long Lasting Effect on Low Back Pain

MedicalResearch.com Interview with:

Dan Cherkin PhD Emeritus Senior Investigator Group Health Research Institute Seattle, WA 98101

Dr. Dan Cherkin

Dan Cherkin PhD
Emeritus Senior Investigator
Group Health Research Institute
Seattle, WA 98101

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

Response: We previously reported the results of a randomized trial examining the effectiveness of Mindfulness-based stress reduction (MBSR) and cognitive behavioral therapy (CBT) for persons with chronic low back pain (Cherkin et al, JAMA, March 22, 2016).

The current report examines whether the relative effectiveness of these approaches compared with usual care that we found after one year were still evident after two years. We found that there was little decrease in the magnitude of the effects of both MBSR and CBT between one and two years, but the two-year outcomes were statistically significant only for chronic low back pain. As previously reported for outcomes up to one year, there were no significant differences in outcomes between CBT and MBSR.

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