Addiction, Author Interviews, Cocaine, Pain Research / 18.08.2021

MedicalResearch.com Interview with: Youngeun Armbuster Geisinger Commonwealth School of Medicine Scranton, Pennsylvania MedicalResearch.com: What is the background for this study? Response: Cocaine is classified by the U.S. Drug Enforcement Administration (DEA) as a Schedule II drug that can be used as an anesthetic in various types of surgery by otorhinolaryngologists, as well as in diagnosing Horner syndrome. Although controlled doses of cocaine used in topical anesthetics does not cause myocardial infarction as can occur with recreational dosages, intranasal administration of cocaine is absorbed systemically and it results in vasoconstriction of the coronary arteries via stimulation of adrenergic receptors. These potential adverse effects may disincentivize health care providers from medical cocaine use. Our objective was to quantify the trends in licit cocaine distribution in the United States using DEA data and to determine the usage of medical cocaine in Medicaid and Medicare, as well as based on electronic medical records [1]. (more…)
Author Interviews, NEJM, Neurology, Pain Research / 18.08.2021

MedicalResearch.com Interview with: Jessica Ailani M.D. FAHS FAAN FANA Director Medstar Georgetown Headache Center Vice Co-Chair of Strategic Planning for MedStar Neurology Professor of Clinical Neurology MedStar Georgetown University Hospital MedicalResearch.com: What is the background for this study? Response: Migraine is a common neurological disease that causes disabling attacks that can be frequent. Preventive treatments can help reduce the frequency of attacks and improve patient function, reducing disease burden. (more…)
Author Interviews, Brigham & Women's - Harvard, Clots - Coagulation, Hematology, Neurological Disorders, Pain Research / 22.05.2021

MedicalResearch.com Interview with: Daniel Chasman, PhD Pamela Rist, ScD, Yanjun Guo, MD, PhD Division of Preventative Medicine Brigham and Women’s Hospital  MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been speculation in the field about relationships between coagulation and migraine susceptibility for some time, but previous research has been largely inconclusive. In this study, we leveraged Mendelian randomization, a mode of genetic analysis that can support or refute potential causal effects on a health outcome, to examine whether hemostatic factors may contribute to risk of MA. (more…)
Author Interviews, Diabetes, Neurology, Pain Research / 10.12.2020

MedicalResearch.com Interview with: William K. Schmidt, Ph.D. Senior VP Clinical Development Helixmith Co. Ltd.  MedicalResearch.com: What is the background for this study? How common is diabetic peripheral neuropathy and how does it affect patients? Response: According to the Centers for Disease Control and Prevention (CDC), over 34 million people in the United States have diabetes (about 10% of the U.S. population) and about one in four patients do not know that they have it (https://www.cdc.gov/chronicdisease/resources/publications/factsheets/diabetes-prediabetes.htm).  Diabetes can cause significant damage to nerves in the feet, hands, eyes, and other parts of the body. Diabetic peripheral neuropathy (DPN) is the most common form of nerve damage worldwide; it affects approximately half of the patients with diabetes (Iqbal et al., 2018).  In many individuals, severe burning, tingling, “pins and needles,” or cramping pain can occur simultaneously in both feet without external evidence of foot damage. Despite the pain, symptoms may be accompanied by numbness or loss of sensation in the feet. This is called painful diabetic peripheral neuropathy (painful DPN or P-DPN) and may affect up to one-third of the general diabetic population (Yoo et al., 2013). P-DPN may cause increased anxiety and depression, sleep impairment, and difficulties with walking.  Up to one-third of P-DPN patients may require the use of a cane, walker, or even a wheelchair due to extreme foot pain.  Once P-DPN occurs, it may result in a lifetime of pain and disability. FDA-approved daily oral medications often used to treat P-DPN include Neurontin (gabapentin), Lyrica (pregabalin), Cymbalta (duloxetine), and Nucynta ER (tapentadol).  While these “neuropathic pain” medications may dull the pain for some subjects, they produce significant side effects that may be troubling for many patients. Indeed, many patients stop using these pain killers due to lack of effectiveness at doses that they can tolerate (van Nooten et al., 2017) There is also a topical 8% capsaicin patch, but again with limited efficacy. It is well known that the most severely affected patients may require opioid analgesics to control P-DPN (Pesa et al., 2013). None of the currently used medications have disease-modifying effects. However, our new injectable medication is now in advanced clinical development that has the potential disease-modifying effects lasting months after each treatment, with limited or no side effects for most patients aside from brief injection site discomfort. (more…)
Author Interviews, Gender Differences, JAMA, Pain Research / 29.09.2020

MedicalResearch.com Interview with: Jason Nagata, MD, MSc Assistant Professor of Pediatrics University of California, San Francisco San Francisco, California  MedicalResearch.com: What is the background for this study? Response: Although prior research has identified disparities in migraine by race and sex, little was previously known about disparities in migraine by sexual orientation.  MedicalResearch.com: What are the main findings?  Response: In a national sample of nearly 10,000 adults in the USA, we found that nearly one third of lesbian, gay, and bisexual individuals have experienced a migraine. Overall, we found that lesbian, gay, or bisexual individuals had 58% higher odds of experiencing a migraine compared to heterosexual individuals. We also found that individuals who identified as mostly heterosexual but with some same-sex attractions were more likely to experience a migraine compared to those who identified as exclusively heterosexual. (more…)
Author Interviews, Pain Research / 28.07.2020

MedicalResearch.com Interview with: Hernan Bazan, MD DFSVS FACS CEO & Co-founder, South Rampart Pharma, LLC and Professor of Surgery, Section of Vascular/Endovascular Surgery Program Director, Vascular Surgery Fellowship Ochsner Clinic  New Orleans, LA  70121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The work in this paper is in large part due to several active and productive collaborations to address a simple problem: introduce a safer way to treat pain. That is, without the risk of opioids (abuse potential), acetaminophen/paracetamol (liver toxicity) and non-steroidal anti-inflammatory drugs (NSAIDs)/ibuprofen (kidney toxicity). Acetaminophen hepatotoxicity remains the most common cause of acute liver failure in the U.S. with inadvertent hepatotoxicity the etiology in half of all case.  Our aim was to overcome this toxicity by creating acetaminophen analogs and this paper describes the rationale for this synthesis, the library of compounds used to select the lead compounds to develop, the consistent lack of hepatotoxicity cell lines and small animals, and its ability to reduce pain and fever in small animal studies. Moreover, we explain the mechanisms of action for the lack of hepatotoxicity. One mechanism for acetaminophen-induced hepatotoxicity is via formation of the electrophilic reactive metabolite, NAPQI. Using ultraperformance liquid chromatography tandem mass spectrometry (LC-MS/MS) to detect NAPQI, we observed that after CD1 mice were exposed to high doses (600 mg/kg) of either acetaminophen or SRP compounds, only acetaminophen-, but not SRP-compound-treated mice, generated the toxic metabolite NAPQI. Another mechanism for acetaminophen hepatotoxicity is loss of hepatic tight junctions and chicken wire’ hepatic tight junctions remain intact in SRP-treated animals while these junctions are lost in acetaminophen-treated animals.  (more…)
Author Interviews, JAMA, Pain Research / 11.06.2020

MedicalResearch.com Interview with: Tobias Kurth, MD, ScD (Pronouns: he/him) Professor of Public Health and Epidemiology Director, Institute of Public Health Charité – Universitätsmedizin Berlin  MedicalResearch.com: What is the background for this study? Response: Migraine (with aura) has been associated with increased risk of cardiovascular disease but its absolute contribution in relation to other major vascular risk factors was not unclear. (more…)
Author Interviews, Neurological Disorders, Neurology, Pain Research / 11.05.2020

MedicalResearch.com Interview with: Holly Yancy, DO Headache medicine specialist Banner – University Medicine Neuroscience Institute Phoenix, AZ Dr. Yancy comments on the recent Neurology journal article on the potential impact of yoga on migraine.  MedicalResearch.com: What is the background for this study? How might yoga reduce migraine intensity or frequency?  Response: The authors of this trial have studied the benefits of yoga when added to medical management of episodic migraine. They expand on prior, smaller reports of the potential benefit of yoga and mindfulness to migraine patients with a well-designed study that shows yoga, as an adjunct to preventive medication, can lower the intensity, frequency and impact of migraines. Participants even used less abortive medication. The authors propose multiple potential mechanisms of action, including an increase in parasympathetic / decrease in sympathetic nervous system activity, decreased muscle tension, and stress management. (more…)
Author Interviews, Dental Research, JAMA, Pain Research / 19.03.2020

MedicalResearch.com Interview with: Dr. Romesh P. Nalliah BDS, MHCM Associate Dean for Patient Services Clinical Professor Institute for Healthcare Policy & Innovation Michigan Institute for Data Science Director, Synergy Program MedicalResearch.com: What is the background for this study? Response: We designed and conducted this study because there is a paucity of knowledge related to opioid prescribing for acute dental pain. (more…)
Author Interviews, Neurology, Pain Research / 12.02.2020

MedicalResearch.com Interview with: Chun Yuen Fong Post-doc research fellow Center for Cognitive and Evolutionary Science University of Tokyo  MedicalResearch.com: What is the background for this study? Response: Migraine is one of the most prevalent neurological disorders worldwide. However, what exactly trigger a migraine episode is not entirely clear despite years of research. Moreover, migraine sufferers often report having excessive sensitivity to light and certain patterns during the headache-free period. Some researchers suggested that such abnormal sensations were associated with the enhanced cortical hyperexcitability of the migraine sufferers. In our study, we aimed to build on this theory by comparing the neurophysiological activities between regular migraine sufferers and control using electroencephalography (EEG). Using the same research method, we also compared the neural activities between healthy participants who reported having more abnormal visual sensations to those with less. (more…)
Author Interviews, OBGYNE, Opiods, Pain Research / 28.01.2020

MedicalResearch.com Interview with: Dave Stack Chief Executive Officer and Chairman Pacira BioSciences  MedicalResearch.com: What is the background for this study? Response: Cesarean sections (C-sections) are one of the most common surgeries in the United States, and research shows many women experience moderate to severe pain after this procedure. When postsurgical pain is inadequately managed for new mothers, it can interfere with recovery, maternal-infant bonding and may even lead to postpartum depression. Additionally, prescribing data reveals that postsurgical opioid consumption poses a great risk to women. We recently completed a Phase 4 study of EXPAREL in C-section patients, and results revealed adding EXPAREL to bupivacaine transversus abdominis plane (TAP) blocks for C-section delivery provided significant reductions in opioids and pain scores. Results of that study provided the basis for the design of this next-generation study, which was created to be completely opioid-free in the EXPAREL arm. The study was a Phase 4 multicenter, active-controlled study conducted in 18 clinical sites in the United States, with 169 enrolled patients undergoing elective C-section. The enrolled C-section patients were randomized to receive either 150 mcg morphine spinal anesthesia plus a standard of care postoperative pain regimen, 50 mcg morphine spinal anesthesia plus EXPAREL TAP field block, or opioid-free spinal anesthesia plus EXPAREL TAP block. Patients in the EXPAREL arms received a protocol-defined non-opioid postsurgical pain management regimen including ketorolac, acetaminophen, and ibuprofen.  (more…)
Author Interviews, OBGYNE, Pain Research / 17.01.2020

MedicalResearch.com Interview with: Rafael Maldonado Lopez MD PhD Full professor Departament de Ciències Experimentals i de la Salut Universitat Pompeu Fabra Barcelona MedicalResearch.com: What is the background for this study? Response: Endometriosis is a common, chronic and painful disease caused when the endometrium grows outside of the uterine cavity. These growths mainly affect organs in the pelvis causing pain and infertility, symptoms that are often accompanied with anxiety, depression, loss of working ability, and a substantial impact on quality of life. Current treatments include hormonal therapy and surgery, but the effectiveness of these treatments is rather limited, often have important unwanted side effects, and patients usually rely on self-management strategies. Therefore, there is an urgent need for researching new possible therapeutic approaches.  (more…)
Author Interviews, JAMA, Neurology, Ophthalmology, Pain Research / 27.11.2019

MedicalResearch.com Interview with: Priv.-Doz. Dr. med. Christoph Schankin Consultant Head University Headache Clinic Department of Neurology Inselspital, Bern University Hospital University of Bern MedicalResearch.com: What is the background for this study? Response: Visual snow syndrome is a debilitating disorder with a continuous TV snow-like visual disturbance that persists over years. Patients have additional visual problems, such as severe afterimages, floaters or photophobia. The syndrome is associated with migraine and migraine aura, but the interaction between the two remains unclear. (more…)
Author Interviews, Pain Research, Rheumatology / 11.11.2019

MedicalResearch.com Interview with: Féline PB Kroon MD Department of Rheumatology Leiden University Medical Centre LUMC · MedicalResearch.com: What is the background for this study? Response: Hand osteoarthritis (OA) is a prevalent joint condition that causes pain, functional disability, and decreased quality of life, for which patients frequently consult health-care providers. Symptoms usually fluctuate over time, with episodes of joint swelling and erythema. Evidence from previous studies has shown that inflammation plays an important role in the disease, being an important predictor for pain and radiographic damage progression. Therefore, we hypothesized that inflammation could be a treatment target in OA, and we investigated this using prednisolone, a potent anti-inflammatory drug. The aim of the HOPE study was to investigate the clinical efficacy and safety of a six-week course of prednisolone 10 mg daily in patients with painful hand OA who had evidence of synovial inflammation. (more…)
Author Interviews, Pain Research, Rheumatology / 12.09.2019

MedicalResearch.com Interview with: W. Benjamin Nowell, Ph.D. Director of Patient-Centered Research CreakyJoints, Principal Investigator of ArthritisPower MedicalResearch.com: What is the background for this study? Response: Over the past fifteen years, the treatment options for people diagnosed and living with rheumatoid arthritis (RA) have grown. There are now many medications (particularly biologic disease-modifying antirheumatic drugs, or bDMARDs) proven to improve disease symptoms and immune system over activity, thereby reducing inflammation and joint damage. The American College of Rheumatology recommends a treat-to-target approach, which has the patient and rheumatologist setting goals for treatment effectiveness and making adjustments over time to meet those goals. This study aimed to determine if rheumatoid arthritis patients are satisfied with their treatment. The goal of this study was to identify the following: patients’ satisfaction with current RA treatment, the current unmet needs perceived by patients with rheumatoid arthritis in the United States, the symptoms of rheumatoid arthritis that are most bothersome to patients, and the impact of symptoms on function and quality of life that may lead patients to need alternative treatments.  (more…)
Author Interviews, Global Health, Mental Health Research, Pain Research, Psychological Science / 07.09.2019

MedicalResearch.com Interview with: Dimitris Xygalatas, PhD Assistant Professor, Anthropology (Affiliate) Institute for Collaboration on Health, Intervention, and Policy (InCHIP) UCONN MedicalResearch.com: What is the background for this study? Response: Ever since I was a graduate student, I have been intrigued by the performance of ritual practices that involve pain, bodily harm, and other forms of suffering. These rituals carry obvious risks, including health risks, but despite these risks they are performed voluntarily by millions of people around the world. And even more intriguing is the fact that in various contexts such rituals are often culturally prescribed remedies for a variety of maladies. When I was doing my doctoral fieldwork, I studied the fire-walking rituals of the Anastenaria in Northern Greece, and I heard several people describing their experience of participation as one that involved both suffering and healing. And of course I am not the first anthropologist to document this link. But these observations seemed puzzling to me. Some years later, I met one of the co-authors of this paper, Sammyh Khan, who was asking very similar questions. We got a grant to design this study, and put together a team of researchers that spent two months in the field collecting data for this project. We studied the Hindu kavadi ritual, which involves piercing the body with numerous needles, hooks, and skewers, and various other forms of suffering. Our study took place in the island of Mauritius, where I have been conducting research over the last decade, but this ceremony is performed by millions of Hindus around the world. We used portable health monitors as well as interviews and survey instruments to document the effects of this ritual of psycho-physiological health and wellbeing.  (more…)
Author Interviews, Global Health, Opiods, Pain Research, Primary Care / 26.07.2019

MedicalResearch.com Interview with: Marisha Burden, MD, FACP, SFHM Associate Professor of Medicine Division Head of Hospital Medicine University of Colorado School of Medicine MedicalResearch.com: What is the background for this study? Response: The United States has seen a marked increase in opioid prescribing since 2000 and while there has been a slight decline in prescribing since 2012, prescription rates for opioids still remain much higher than in the late 1990’s and are considerably higher when compared to other countries. The US continues to see opioid-related complications such as overdoses, hospitalizations, and deaths. Hospitalized patients frequently experience pain and opioid medications are often the mainstay for treatment of pain. Studies have suggested that receipt of opioid prescriptions at the time of hospital discharge may increase risk for long-term use. (more…)
Author Interviews, Dental Research, Opiods, Pain Research / 05.07.2019

MedicalResearch.com Interview with: Dr. Stuart Lieblich, DMD Oral and maxillofacial surgeon  Avon, CT MedicalResearch.com: What is the background for this study? How does EXPAREL® differ from other pain medication for dental work or other short-term procedures? Response: This study analyzed the use of opioids and non-opioid options for postsurgical pain following third molar extraction (wisdom teeth removal). Our research team reviewed data from 600 patients who underwent third molar extraction, with 300 patients having received non-opioid option EXPAREL (bupivacaine liposome injectable suspension) and 300 patients that did not receive an infiltration of EXPAREL. The study aimed to show that reducing opioid prescriptions following this procedure may decrease opioid-related adverse events and the risk of opioid dependence. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA, Pain Research / 21.06.2019

MedicalResearch.com Interview with: Changchuan (Charles) Jiang MD, MPH MSSLW Internal Medicine Residency Program Class of 2020 Ichan School of Medicine at Mount Sinai MedicalResearch.com: What is the background for this study? Response: Chronic pain is one of the common side effects of cancer treatments and it has been linked to low life quality, lower adherence to treatment, higher medical cost. As the population of cancer survivors grows rapidly, chronic pain will be a major public health issue in this population. We know from previous studies that chronic pain is common in certain cancers such as breast cancer. However, little was known about the epidemiology of chronic pain in the cancer survivors until our study. (more…)
Author Interviews, Depression, Pain Research, Psychological Science / 19.06.2019

MedicalResearch.com Interview with: Dr. Markus Rütgen PhD Post-doctoral researcher Social, Cognitive and Affective Neuroscience Unit Faculty of Psychology University of Vienna  MedicalResearch.com: What is the background for this study? Response: Previous research has reported empathy deficits in patients with major depressive disorder. However, a high percentage of patients taking part in these studies were taking antidepressants, which are known to influence emotion processing. In our study, we wanted to overcome this important limitation. We were interested in whether the previously reported empathic deficits were attributable to the acute state of depression, or to the antidepressant treatment. To this end, we performed a longitudinal neuroimaging study, in which we measured brain activity and self-reported empathy in response to short video clips showing people in pain. We measured acutely depressed patients twice. First, before they started their treatment, second, after three months of treatment with a state-of-the-art antidepressant (selective serotonin reuptake inhibitors). (more…)
Author Interviews, Opiods, Pain Research, Sleep Disorders / 05.06.2019

MedicalResearch.com Interview with: Nicole Tang, D.Phil, C.Psychol (Reader) Department of Psychology Warwick Sleep and Pain Lab University of Warwick MedicalResearch.com: What is the background for this study? What are the main findings? Response: Current guidelines recommend non-opioid therapy as the preferred treatment of chronic non-malignant (CNP) pain, with opioids reserved to situations “when benefits for pain and function are expected to outweigh risks” [1,10]. Whilst the effectiveness of opioid therapy is usually measured in terms of pain outcomes, less is known about its effect on day-to-day functions. A particular function of concern to patients with chronic non-malignant pain is the ability to get a good night's sleep. The current systematic review has identified a set of papers with relevant outcomes regarding the effect of opioid therapy on sleep quality and sleep architecture in CNP patients. It extends our understanding from the drug's respiratory depression effect in healthy individuals to the potential risks and utility of opioid therapy for chronic non-malignant pain patients with sleep disturbances. Whilst the narrative synthesis and the exploratory meta-analysis of a subset of data both suggest that the use of opioid therapy is associated with an overall report of sleep quality improvement, such an improvement is not consistently replicated across studies or substantiated by improvements in sleep parameters linked to deeper and better-sleep quality. Moreover, the improvement may be accompanied by undesirable side effects and increased daytime sleepiness that contradict with the very idea of improved sleep quality. We are also painfully aware of the methodological limitations of the studies reviewed; their exposure to different sources of biases has heightened the risk of result inflation. To many patients with chronic non-malignant pain, improved sleep is a top priority when evaluating the performance of a new drug and non-drug intervention. If we were to advance our current understanding of the opioid-sleep relationship, future trials need to be designed with this interdisciplinary question in mind such that validated measures of sleep can be incorporated as an outcome measure alongside pain. (more…)
Anesthesiology, Author Interviews, Duke, OBGYNE, Opiods, Pain Research, Surgical Research / 29.05.2019

MedicalResearch.com Interview with: Ashraf Habib, MDChief of the Division of Women’s Anesthesia and Professor of AnesthesiologyDuke University Ashraf Habib, MD Chief of the Division of Women’s Anesthesia Professor of Anesthesiology Duke University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was a multicenter study conducted in 13 clinical sites in the United States enrolling patients undergoing elective Cesarean-section and receiving spinal anesthesia. 186 patients were enrolled and randomized to receive EXPAREL, a long-acting, non-opioid option to manage postsurgical pain, administered via transversus abdominis plane (TAP) field block, mixed with plain bupivacaine or TAP block with plain bupivacaine alone. A TAP block numbs the nerves that supply the abdominal wall. We presented the data at the 51st Annual Meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) in Phoenix, AZ. We aimed to collect clinical evidence that a multimodal postsurgical pain regimen using a TAP block with EXPAREL (bupivacaine liposome injectable suspension) together with regularly scheduled acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce opioid consumption more so than a standard multimodal pain control approach that combines TAP block with standard bupivacaine, regularly scheduled acetaminophen, and NSAIDs. (more…)
Author Interviews, Dental Research, Opiods, Pain Research / 23.05.2019

MedicalResearch.com Interview with: Dr. Katie Suda, PharmD, M.S. Associate Professor College of Pharmacy University of Illinois at Chicago Dr. Susan Rowan, DDS Clinical Associate Professor, Executive Associate Dean of Clinical Affairs College of Dentistry University of Illinois at Chicago,  MedicalResearch.com: What is the background for this study?  Dr. Katie Suda: Dentists treat a lot of pain – we have all probably had the experience of a terrible tooth ache. All dentists treat pain worldwide so we would not expect a large difference in which pain medication is prescribed. However, our results show that US dentists prescribe opioids more frequently than is likely needed. This is especially true because studies have shown that non-opioid pain medications are similar or more effective for the treatment of oral pain.  (more…)
Author Interviews, Brigham & Women's - Harvard, Opiods, Orthopedics, Pain Research, Surgical Research / 16.05.2019

MedicalResearch.com Interview with: Marilyn M. Heng, MD, MPH, FRCSC Orthopaedic Trauma Surgeon Assistant Professor of Orthopaedic Surgery Harvard Medical School  MedicalResearch.com: What is the background for this study?   Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids. The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that.  (more…)
Author Interviews, Opiods, Pain Research / 06.05.2019

MedicalResearch.com Interview with: Jan Klimas, PhD, MSc Senior Postdoctoral Fellow BC Centre on Substance Use (BCCSU) Vancouver, BC MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Some individuals prescribed opioid analgesic medications for pain develop opioid use disorder. So, much research has been conducted to develop strategies to identify patients who can be safely prescribed opioid analgesics. However, this research has not been critically reviewed through rigorous quality assessment. This study therefore sought to identify signs, symptoms & screening tools to identify patients with pain who can be safely prescribed opioids  (more…)
Author Interviews, Cancer Research, JAMA, Pain Research / 19.04.2019

MedicalResearch.com Interview with: Robert C. Miller, MD, MS, MBA Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida University of Maryland School of Medicine, Baltimore MedicalResearch.com: What is the background for this study? What are the main findings? Response: "Magic Mouthwash" is one of the most commonly prescribed medications for oral mucositis pain during cancer therapy, but there has not been good evidence in the past to support its use. This trial is the first large randomized controlled trial to demonstrate that both "Magic" mouthwash and doxepin rinse reduce patient reported pain during cancer therapy. (more…)
Author Interviews, ENT, JAMA, Pain Research, Pediatrics, Surgical Research / 05.04.2019

MedicalResearch.com Interview with: Gillian R. Diercks, MD, MPH Instructor in Otolaryngology, Harvard Medical School Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston, Massachusetts  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually.  A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration. In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home.  This leaves limited options for pain control, including acetaminophen and ibuprofen.  However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood.  At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding.  Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead. Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher. (more…)
Author Interviews, Orthopedics, Pain Research / 19.03.2019

MedicalResearch.com Interview with: Geoffrey Westrich, MD Director of Research Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery NYC  MedicalResearch.com: What is the background for this study? Response: Recent mortality trends in the U.S. associated with opioid use disorders have brought to the forefront of national debate the desirability of minimizing the use of potentially addictive pain management therapies.  Pain management after hip replacement surgery is an important part of patient care, and  opioids are frequently given as a major part of postoperative pain management. At the same time, multimodal analgesia, the administration of anesthetic agents and medications agents targeting multiple pain pathways, has seen increased popularity in pain management after hip replacement surgery.  At Hospital for Special Surgery (HSS), the multimodal protocol entails the use of several different anesthetic agents and medications both during and after surgery to control pain, minimize the use of opioids and reduce side effects. The use of non-opioid analgesics such as acetaminophen allows for a reduction in opioid administration after surgery [1]. Acetaminophen, commonly known as Tylenol, has traditionally been administered orally, but more recently an intravenous (IV) preparation has become available.  IV acetaminophen after major orthopedic surgery was shown to provide effective analgesia and reduce morphine administration by 33%, compared to placebo [2]. Unless a patient is unable to take acetaminophen, it is commonly used as part of the multimodal protocol due to its efficacy and minimal contraindications. Although intravenous (IV) acetaminophen presents pharmacokinetic benefits, such as increasing both serum blood and cerebrospinal fluid levels more rapidly, there is limited analysis of its potential clinical advantages compared to oral acetaminophen.  We hypothesized that there could be a reduction in pain with activity, opioid usage, or opioid- related side effects among patients receiving IV acetaminophen compared to oral acetaminophen following hip replacement surgery  (more…)