Author Interviews, Kidney Disease, Neurological Disorders, Pain Research, UCSF / 06.06.2018 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 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.  (more…)
Author Interviews, Pain Research, Pharmaceutical Companies / 04.06.2018 Interview with: Zosano Pharma Dr. Peter Schmidt, MD, MSc Senior Director, medical Affairs and Clinical Development Zosano Pharma 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). (more…)
Addiction, Author Interviews, Opiods, Pain Research / 23.05.2018 Interview with: 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. 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. (more…)
Author Interviews, JAMA, Orthopedics, Pain Research / 21.05.2018 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 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. (more…)
Author Interviews, Infections, Pain Research, PLoS, Urinary Tract Infections / 17.05.2018 Interview with: Ingvild Vik MD Doctoral Research Fellow Department of General Practice Institute of Health and Society - UiO University of Oslo, Norway 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.  (more…)
Author Interviews, Biomarkers, Brigham & Women's - Harvard, Orthopedics, Pain Research / 11.05.2018 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 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.  (more…)
Author Interviews, JAMA, Pain Research, Psychological Science / 07.05.2018 Interview with: 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 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). (more…)
Author Interviews, Brigham & Women's - Harvard, Emergency Care, Pain Research / 07.05.2018 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 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.  (more…)
Author Interviews, Dental Research, Pain Research, University of Pittsburgh / 03.05.2018 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 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. (more…)
Author Interviews, Orthopedics, Pain Research, Rheumatology / 02.05.2018 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 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. (more…)
Author Interviews, Gastrointestinal Disease, Pain Research / 09.04.2018 Interview with: Dr. Joseph Pergolizzi MD Senior Partner and Director of Research Naples Anesthesia and Pain Associates Naples, Florida 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.
Author Interviews, BMJ, Heart Disease, Pain Research, Stroke / 04.04.2018 Interview with: Islam Elgendy MD Division of Cardiovascular Medicine University of Florida 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.  (more…)
Author Interviews, BMJ, Pain Research, Rheumatology / 22.03.2018 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 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. (more…)
Annals Internal Medicine, Author Interviews, Pain Research, Rheumatology / 21.02.2018 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 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. (more…)
Author Interviews, BMJ, Heart Disease, Pain Research, Stroke / 01.02.2018 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 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. 
Author Interviews, Pain Research, Surgical Research / 05.01.2018 Interview with: “Migraine” by makelessnoise is licensed under CC BY 2.0Lisa Gfrerer, MD PhD Clinical Fellow in Surgery Brigham and Women's Hospital William Gerald Austen MD Chief, Plastic and Reconstructive Surgery Chief, Division of Burn Surgery Massachusetts General Hospital What are the main findings? Response: Migraine surgery patients at our institution are chronic pain patients who have failed conservative therapy and are severely disabled by their disease. We initiated this study to understand two important points. First, it was previously unclear how to categorize these patients in terms of pain intensity and disability on the spectrum of better known pain conditions such as chronic back pain/ nerve pain/ carpal tunnel.  This is very important to appreciate the extent of this disease. Second, instead of collecting migraine characteristic such as decrease in migraine days/ duration/ pain, we wanted to understand how functionally disabled these patients are in their daily lives and how much better they get after surgery. This is ultimately what matters to patients. We therefore decided to evaluate our outcomes by using the Pain Self Efficacy Questionnaires (PSEQ). This validated pain questionnaire has been used to describe pain intensity/disability in patients with different acute and chronic pain conditions. (more…)
Author Interviews, JAMA, Johns Hopkins, Opiods, Pain Research / 12.12.2017 Interview with: “Pills” by Victor is licensed under CC BY 2.0Marissa J. Seamans, Ph.D Postdoctoral Fellow Department of Mental Health Johns Hopkins School of Public Health Baltimore, MD 21205 What is the background for this study? What are the main findings? Response: Many patients report sharing their prescriptions for opioids with family members. What we didn’t know is whether family members of opioid users are more likely to fill opioid prescriptions themselves than family members of non-opioid users. Our study found that the 1-year risk of prescription opioid initiation among family members of prescription opioid users was an absolute 0.71% higher than among family members of non-opioid users. The risks were particularly higher for initial prescriptions with refills or longer days supply. (more…)
Author Interviews, Gastrointestinal Disease, Pain Research / 28.11.2017 Interview with: Charles Melbern (Mel) Wilcox, MD, MSPH Director of the division of Gastroenterology and Hepatology University of Alabama-Birmingham What is the background for this survey? What are the main findings? Response: Nearly every person experiences pain at some point in their life – for many, the pain is acute and occasional, but for others, the pain is chronic and can be debilitating. Research shows that more than 25.3 million Americans suffer from daily pain and, every year, consumers purchase more than $20 billion per year on over-the-counter (OTC) pain medicines. In my work with the American Gastroenterological Association, we set out to explore the behaviors, beliefs, and misunderstandings that Americans have when it comes to OTC pain medicines. We surveyed 1,015 U.S. adults and 251 gastroenterologists to gain insight on how they were approaching pain management and OTC pain medicine use. The survey found that Americans are routinely ignoring OTC pain medicine labels and are not consulting their health-care professionals about their pain before taking OTC pain medicines. As a direct result, gastroenterologists are noticing their patients experiencing complications and unintentional overdose symptoms. They see an average of 90 overdose cases each year, about two a week, due to OTC pain medicine overdose. Ninety percent of gastroenterologists believe their patients require more and better education on how to use OTC pain medicine safely. They find that patients are not fully understanding the harms associated with taking too much. When asked why patients take more than the recommended dose, Americans say that they are confident in their ability to manage their medication (32 percent) or they wanted to feel better faster, mistakenly thinking more medicine would be the solution (73 percent). (more…)
Author Interviews, CT Scanning, Emergency Care, Pain Research / 14.11.2017 Interview with: Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario What is the background for this study? What are the main findings? Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes. The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance. We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%. (more…)
Author Interviews, Pain Research, Radiology / 12.11.2017 Interview with: Dr. Alessandro Napoli Dipartimento di Scienze Radiologiche Unità di Terapia con Ultrasuoni Focalizzati Sapienza Università di Roma, Policlinico Umberto I Rome What is the background for this study? What are the main findings? Response: Low back pain and sciatica are very common conditions affecting at least 80% of the population (once in life) with detrimental impact on quality of life. Pain cause is often a lumbar disc herniation with sciatic nerve compression. Treatment strategy is primarily conservative (drugs and physical therapy) and when symptoms are persisting for more than 4 consecutive weeks, surgery is advocated. Many patients prefer to avoid surgery for multiple reasons (recurrence rate, risk-related to the intervention and post-surgical sequela). Technology advances with percutaneous techniques allowed more recently to fill the gap between conservative strategy and surgery for the management of lumbar disc herniation and related low back pain extending to the leg(s). Patients are offered local injection for symptoms relief with limited results. Therefore, other non-to-mini invasive approaches are clinically tested for prolonged clinical efficacy. Pulsed radiofrequency is a promising percutaneous approach mainly used for chronic pain. We aimed to test pulsed radiofrequency in patients refractory to conservative treatments, indicated to surgery. Our study demonstrated that radiofrequency with pulsed technique, performed under CT image guidance, is able to control pain in a surgical-free, single session, lasting 10 minutes. The procedure is highly attractive since can be considered nearly risk-free with high rate of success. In our series 80% of patients treated with pulsed radiofrequency resulted pain free (VAS pain score 0 out of 10) at 1, 3 and 12 months follow-up; 90% did not required anymore surgery. (more…)
Author Interviews, Cancer Research, Opiods, Pain Research / 06.11.2017 Interview with: Sebastiano Mercadante, MD Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center Department of Anesthesia, Intensive Care & Emergencies University of Palermo Palermo, Italy What is the background for this study? What are the main findings? Response: There are many clinical experiences suggesting that methadone, when optimally used by skilled physicians, has invaluable properties in the management of cancer pain. Methadone used as first opioid may provide interesting advantages due to the low tendency to induce tolerance, while providing a clinical profile similar to that of other opioids. Moreover, methadone possesses other extra-opioid effects that can be of interest. (more…)
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 31.10.2017 Interview with: Philipp Gerner MD Candidate - Class of 2018 University of Massachusetts Medical School What is the background for this study? What are the main findings? Response: Over 1 million patients undergo total joint replacement surgery in the United States alone every year, with many experiencing significant pain postoperatively. These procedures often require large amounts of pain medication to keep patients comfortable, which historically has been treated with opioids. Currently, increasing awareness of safe opioid prescribing has created an increased interest in other ways to effectively treat post-operative pain without the dangers and side-effects of opioids. As part of an analysis of the impact of multimodal pain management (i.e. multiple drug classes or procedures to treat post-operative pain) and opioid usage, we conducted this study to considered how trends have changed over the last 10 years. Our data shows that opioid use for post-operative pain has declined substantially in patients undergoing total hip and knee arthroplasty (THA & TKA), two very common and often painful orthopedic procedures. Patients being treated with opioids alone for THA decreased from 47.6% in 2006 to 7.5% in 2016, with similar trends being seen in TKA patients. Importantly, our data also showed that patients are increasingly being treated with a multimodal approach to pain control; especially patients being treated with 3 or more different pain modalities increased sharply in the last 10 years for both procedures in our study. This allows patients the benefit of managing their pain without many of the side-effect associated with large doses of a single pain medication. This trend was found to be especially true in small and medium sized hospitals, compared to larger hospitals. With increasing emphasis on limiting opioid use, this data shows us that the medical community is actively pursuing alternate possibilities for successfully treating post-operative pain. (more…)
Author Interviews, Mental Health Research, Pain Research / 20.10.2017 Interview with: Fu-Chi Yang, M.D., Ph.D.Assistant Professor Department of Neurology, Tri-Service General Hospital National Defense Medical Center Taipei, Taiwan What is the background for this study? What are the main findings? Response: Migraineurs are likely to suffer from comorbid depression and anxiety. Furthermore, increased migraine frequency is associated with an increased risk of mood/anxiety disorders. It is not distinguished by grouping frequency of migraine attacks, whether it is associated with severity scores of depression and anxiety. Thus, we evaluated the relationship between severity of depression/anxiety and migraine frequency We mainly found that the severity of depression (BDI and HADS-depression scores) and anxiety (HADS anxiety score) were related to migraine frequency, after adjusting confounding factors. (more…)
Author Interviews, Exercise - Fitness, Pain Research, UCSD / 19.10.2017 Interview with: Erik Groessl PhD Associate Adjunct Professor Family Medicine and Public Health University of California, San Diego What is the background for this study? What are the main findings? Response: Chronic low back pain (cLBP) is prevalent among military veterans, but cLBP treatment options have limited benefits and side effects. This has resulted in efforts to reduce opioid use and embrace nonpharmacological pain treatments. Yoga has been shown to improve health outcomes and have few side effects in non-veteran community samples. Our objective was to study the effectiveness and safety of yoga for military veterans with chronic low back pain. In a study of 150 veterans with cLBP, we found that yoga participants had greater reductions in disability and pain than those receiving usual. Opioid medication use declined among all participants, and no serious side effects occurred. (more…)
Author Interviews, Pain Research / 24.09.2017 Interview with: Mark A. Lumley, Ph.D. Distinguished Professor and Director of Clinical Psychology Training Department of Psychology Wayne State University Detroit, Michigan  48202 and Howard Schubiner, M.D Founder and Director Mind-Body Medicine Center Providence-Providence Park Hospitak Warren, MI 48092 What is the background for this study? What are the main findings? Response: Fibromyalgia is a condition that afflicts many people with chronic pain and other symptoms, which are often severe. There is no clear evidence of tissue damage or other peripheral causes of the symptoms, and experts agree that the pain is real, and its primary source is the brain. Medications for fibromyalgia have limited effectiveness, so psychological and behavioral therapies are core to treatment. Research documents a strong relationship between emotions and pain, and many patients with FM struggle with negative emotions related to difficult life circumstances, such as trauma, abuse, or relationship conflicts. Ironically, most psychological therapies for FM do not address these problems, but rather teach people how to manage their symptoms. Emerging research, however, demonstrates that therapies that help patients engage rather than avoid their difficult emotional experiences improve both psychological and physical symptoms, including pain. Therefore, we developed an emotion-focused therapy, which we call Emotional Awareness and Expression Therapy (EAET), and compared it to both an active education-based control condition and to the leading psychological intervention for fibromyalgia, cognitive-behavior therapy (CBT). The EAET condition was substantially better on multiple outcomes that the control condition 6 months after treatment. Importantly, although EAET did not differ from CBT on many outcomes, EAET was superior than CBT on reducing widespread and in the percentage of individuals achieving substantial pain reduction (that is, at least 50% pain reduction from baseline). (more…)
Author Interviews, Opiods, Orthopedics, Pain Research, Stanford / 21.08.2017 Interview with: Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479 What is the background for this study? What are the main findings? Response: Opioid addiction is a national crisis.  As surgery is thought to be a gateway to opioid misuse, opioid-sparing approaches for pain management following surgery are a top priority. We conducted a meta-analysis of 39 randomized clinical trials of common non-pharmalogical interventions used for postoperative pain management. We found that acupuncture and electrotherapy following total knee replacement reduced or delayed patients’ opioid use. (more…)
Author Interviews, Pain Research, Pharmacology, PLoS / 17.08.2017 Interview with: Harsha Shanthanna MBBS, MD, MSc Associate Professor, Anesthesiology Chronic Pain Physician St Joseph's Healthcare,McMaster University Hamilton, Canada Diplomate in National Board, Anesthesiology (India) Fellow in Interventional Pain Practice (WIP) European Diplomate in Regional Anesthesia and Pain What is the background for this study? Response: Pregabalin (PG) and gabapentin (GB) are increasingly used for nonspecific Chronic Low Back Pain (CLBP) despite a lack of evidence. There have been concerns expressed over their increased prescribing for various non cancer pain indications in recent years. Their use requires slow titration to therapeutic doses and establishing maintenance on a long-term basis. With prolonged treatment, the potential gain over possible adverse effects and risks could become unclear. We searched Cochrane, MEDLINE and EMBASE databases for randomized control trials reporting the use of gabapentinoids for chronic lower back pain treatment of 3 months or more in adult patients. (more…)
Author Interviews, BMJ, Pain Research, Rheumatology / 16.08.2017 Interview with: Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands What is the background for this study? What are the main findings? Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages. For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding. The study did show, however, that glucosamine can be extremely beneficial for pets, and specifically dogs who have joint related issues. Knowing the most valuable sources of glucosamine for dogs is important, as it can be extracted and gained from multiple sources, and each have their own varied levels of quality and potency. (more…)
Author Interviews, Cleveland Clinic, Orthopedics, Pain Research, Surgical Research / 01.08.2017 Interview with: Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH What is the background for this study? What are the main findings? Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns. (more…)
Author Interviews, JAMA, Opiods, Pain Research, Primary Care / 17.07.2017 Interview with: Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts What is the background for this study? Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement. We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing ( We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices. (more…)