Author Interviews, Dermatology, Johns Hopkins, Pain Research / 24.02.2017

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 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. (more…)
Annals Internal Medicine, Author Interviews, Pain Research, Telemedicine / 21.02.2017

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. (more…)
Author Interviews, JAMA, Pain Research / 14.02.2017

MedicalResearch.com Interview with: 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. (more…)
Author Interviews, JAMA, Pain Research, Radiation Therapy / 14.02.2017

MedicalResearch.com Interview with: Rachel McDonald, MD(C) Department of Radiation Oncology Odette Cancer Centre Sunnybrook Health Sciences Centre Toronto, Ontario, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: Radiation treatment has been demonstrated in numerous studies to provide effective and timely pain relief to those suffering from painful bone metastases. However, as a palliative treatment, the goal should be not only to reduce pain but also to maintain and even improve quality of life. To date, studies have not effectively demonstrated this; most of these have included either small sample sizes or utilize questionnaires that aren’t tailored to the palliative cancer population with bone metastases. We aimed to determine how soon after radiation treatment one can expect an improvement in quality of life. Our results showed that patients who had a pain response to radiation also had significantly greater improvements in pain, pain characteristics, functional interference, and psychosocial aspects of well-being at day 10 post-treatment. Further improvements in most domains of quality of life were found for responders at day 42. (more…)
Author Interviews, BMJ, Orthopedics, Pain Research, Surgical Research / 08.02.2017

MedicalResearch.com Interview with: Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse. (more…)
Author Interviews, BMJ, Pain Research, Pharmacology / 07.02.2017

MedicalResearch.com Interview with: Dr. Gustavo Machado BPhty (Hons) Cert.MDT The George Institute for Global Health Sydney Medical School, University of Sydney Sydney, New South Wales, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: People with back pain are usually told by their health care practitioners to take analgesic medications to relieve their pain. But our previous research published in the BMJ showed that paracetamol does not have a measurable impact on patient’s symptoms. This resulted in recent changes in guidelines' recommendations. The 2017 National Institute for Health and Care Excellence (NICE) guidelines/UK no longer recommend paracetamol as a stand-alone intervention for back pain. So now non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as the analgesic of first choice. However, our results show that compared to placebo, commonly used NSAIDs, such as Ibuprofen (e.g. Nurofen) and Diclofenac (e.g. Voltaren), provide only small benefits for people with back pain while increasing the risk of gastrointestinal adverse effects by 2.5 times. (more…)
Author Interviews, BMJ, End of Life Care, Opiods, Pain Research / 21.01.2017

MedicalResearch.com Interview with: Dr. Katherine Irene Pettus, PhD, OSB Advocacy Officer International Association for Hospice and Palliative Care Vice Chair, Vienna NGO Committee on Drugs Secretary NGO Committee on Ageing, Geneva MedicalResearch.com: What is the background for this study? Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Pain Research, Stroke / 13.01.2017

MedicalResearch.com Interview with: Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia Harvard Medical School Clinical Director, Critical Care Division  MedicalResearch.com: What is the background for this study? Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura. Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year. We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge. (more…)
Author Interviews, Nature, Pain Research, Vitamin D / 09.01.2017

MedicalResearch.com Interview with: MedicalResearch.com: What is the background for this study? What are the main findings? Response: Formation of vitamin D in the skin with UVB light from the sun is a main source of vitamin D during summer months, but in the winter months the UVB light is too weak for vitamin D production. Headache prevalence has been suggested to be related to increasing latitude (less UVB light throughout the year) and possibly to be less prevalent during summer (more UVB light), which suggests a possible role for vitamin D exposure. Some previous small studies have suggested that low serum vitamin D levels might be associated with more frequent headache or migraine. Our study included 2601 men from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) from eastern Finland, aged 42-60 years in 1984-1989, which makes it one of the largest studies so far regarding vitamin D and headache. In our study chronic headache (occurring weakly or daily) was reported by 250 men, and men reporting chronic headache had lower serum vitamin D levels than others. When we divided the study population into four groups based on their serum vitamin D levels, the group with the lowest levels had over a twofold risk of chronic headache in comparison to the group with the highest levels. Chronic headache was also more frequently reported by men who were examined outside the summer months of June through September. (more…)
Author Interviews, Pain Research, Pediatrics, Vaccine Studies / 13.12.2016

MedicalResearch.com Interview with:

Dr. Anna Taddio PhD Professor in the Leslie Dan Faculty of Pharmacy University of Toronto Adjunct senior scientist and clinical pharmacist at SickKids MedicalResearch.com: What is the background for this study? Response: We do not know enough about how well different pain interventions work over time and when combined together. In this study, we compared the effectiveness of interventions when layered together, starting from simplest to most complicated in terms of implementation, in the first year of life in infants undergoing routine vaccinations. We compared 4 different treatments: 1. placebo (sham), 2. Educational video for parents about how to soothe their infants, 3) video and sucrose (sugar water), 4) video and sucrose and liposomal lidocaine cream. (more…)
Anemia, Author Interviews, Hematology, Pain Research / 06.12.2016

MedicalResearch.com Interview with: Kenneth I. Ataga, MD Division of Hematology/Oncology University of North Carolina at Chapel Hill Chapel Hill, NC MedicalResearch.com: What is the background for this study? What are the main findings? Response: The available treatments for acute painful episodes (also referred to as vaso-occlusive crises), the most common complication of sickle cell disease, are limited. Findings from the Phase II SUSTAIN study showed that crizanlizumab (formerly SelG1) at 5 mg/kg reduced the median rate of sickle cell disease-related pain crises per year by 45.3% vs. placebo in patients with or without concomitant hydroxyurea therapy. In addition, clinically meaningful reductions in the frequency of painful crises were observed regardless of sickle cell disease genotype.  (more…)
Author Interviews, Dermatology, Pain Research / 06.11.2016

MedicalResearch.com Interview with: Alexander Egeberg, MD PhD Gentofte Hospital Department of Dermatology and Allergy Hellerup Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients with rosacea frequently report symptoms of migraine, and this link has been discussed for many years. However, very little research has actually been performed in this area, and the prevalence varies greatly between studies. We examined the prevalence of migraine in patients with rosacea, nationwide, as well as the risk of new-onset migraine in patients with manifest rosacea. We found a markedly increased prevalence of migraine among patients with rosacea. The risk of new-onset migraine was also higher among patients with rosacea, but only among women. Perhaps most notably was the observation that risk of new-onset migraine was highest among patients older than 50 years. This was surprising, since new-onset migraine in older individuals is often considered a "red flag". (more…)
Author Interviews, Orthopedics, Pain Research, Smoking, Surgical Research / 31.10.2016

MedicalResearch.com Interview with: Dr. David Kusin MD University of Nebraska Medical Center Omaha MedicalResearch.com: What is the background for this study? What are the main findings? Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further. We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms. (more…)
Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research / 18.10.2016

MedicalResearch.com Interview with: Bryan Sakamoto MD, PhD Department of Anesthesia Richard L. Roudebush, Veterans Affairs Medical Center Department of Anesthesia Indiana University School of Medicine Indianapolis, Indiana MedicalResearch.com: What is the background for this study? Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population. (more…)
Author Interviews, FASEB, Heart Disease, Imperial College, Pain Research, Pharmacology / 17.10.2016

MedicalResearch.com Interview with: Dr Nicholas Kirkby BHF Intermediate Fellow | Vascular Biology National Heart & Lung Institute | Imperial College London London MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know drugs like ibuprofen, called ‘non-steroidal anti-inflammatory drugs’ cause an increase in the risk of heart attacks. These side effects cause very real concerns for the many millions of people who rely on them. They are also the reason why there are no new drugs in this class and why they have been withdrawn (2011) for use as a preventative treatment for colon cancer. Previous research from our group suggests that L-arginine supplements may prevent the cardiovascular side effects caused by these drugs. Our findings here suggest that a particular formulations of ibuprofen, called ibuprofen arginate, which is already available in many parts of the world, can act like an L-arginine supplement and that this could potentially protect the cardiovascular system. (more…)
Author Interviews, Cost of Health Care, Opiods, Pain Research / 26.09.2016

MedicalResearch.com Interview with: Jaren Howard, PharmD, BCPS Associate Director Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: The existing scientific literature estimating the healthcare burden of opioid misuse disorders often combines all patients within the broad category of “opioid abuse,” defined as opioid abuse, dependence, or overdose/poisoning. Collectively, these three conditions can significantly increase healthcare costs among commercially insured patients. • Real world medical coding practices present challenges to researchers aiming to separately analyze excess costs by diagnosis, though combining these diagnoses may mask some variation in excess costs. • Furthermore, little is known about the specific drivers of excess costs in terms of medical conditions driving excess costs or places of service at the diagnosis-level. (more…)
Addiction, Author Interviews, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: Thomas Alfieri, PhD Director, Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: When researchers assess the abuse potential of opioids, they follow current FDA guidance, which stipulates that questions such as “Do you like this drug?” and “How much would you like to take this drug again?” be asked of recreational drug users. We think that assessing abuse potential among recreational users provides useful information, however, we believe that the questions designed to be asked of recreational users are not appropriate for use with pain patients. These items can confuse the liking of a drug for pain relief with the liking of a drug to get high – two very different reasons that a pain patient might want to take a drug again. In theory, abuse potential could be overestimated among pain patients because of the somewhat general nature of the items used in the survey instrument. (more…)
Author Interviews, Cost of Health Care, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: Opioid abuse, dependence, overdose, and poisoning (referred to collectively for the purposes of this study as “abuse”) represent a costly public health concern to payers. Excess annual costs for a diagnosed opioid abuser range from $10,000-$20,000 per patient. Current literature does not sufficiently address the drivers of excess costs in terms of medical conditions driving costs or places of service. (more…)
Author Interviews, Opiods, Pain Research / 21.09.2016

MedicalResearch.com Interview with: Angela DeVeaugh-Geiss, PhD Director, Epidemiology, Purdue Pharma L.P. MedicalResearch.com: What is the background for this study? Response: Due to widespread abuse, including abuse via non-oral routes (eg, snorting, injecting), OxyContin was reformulated with abuse deterrent properties in August 2010. In this study we explored changes in nonmedical use of OxyContin after the reformulation using public use data files from the National Survey on Drug Use and Health (NSDUH). NSDUH has included questions about nonmedical use of OxyContin (including pill images) since 2004. Nonmedical use is defined as use without a prescription or use that occurred simply for the experience or feeling the drug caused. (more…)
Addiction, Author Interviews, CDC, Opiods, Pain Research / 27.08.2016

MedicalResearch.com Interview with: John Halpin, MD, MPH, Medical officer Prescription Drug Overdose Epidemiology and Surveillance Team CDC Injury Center MedicalReseach.com editor’s note: Dr. Halpern discusses the CDC alert of August 25, 2016 regarding the increase in fentanyl-related unintentional overdose fatalities in multiple states. MedicalResearch.com: What is the background for this alert? Response: The current health alert is an update to a previous alert in October, 2015 from CDC which described the geographic spread of states in which forensic labs were increasingly detecting fentanyl in the drug submissions that they receive from law enforcement, and how many of these same states were beginning to report fentanyl-related overdose deaths by their departments of public health. Further investigation by CDC and DEA have revealed that the great majority of fentanyl now present in the illicit drugs market is clandestinely-produced, and most commonly mixed with and sold as heroin, and is responsible for the great majority of fentanyl-related overdose deaths. Indications at the time of that alert pointed to a likely continuous rise in the supply of illicitly-manufactured fentanyl, and the potential for increasing numbers of fentanyl-related overdose deaths, particularly among those who use heroin. (more…)
Author Interviews, Pain Research, Pediatrics / 15.08.2016

MedicalResearch.com Interview with: Amy Baxter MD CEO MMJ Labs LLC MedicalResearch.com: Would you tell us a little about your background? How did you develop an interest in pain management and prevention? Response: As a pediatric emergency doctor, I found it interesting that doctors could prevent pain but sometimes couldn't be bothered to do so. The lack of empathy and impatience is built into emergency training - we learn to diagnose and fix things quickly, not comfort and support. I decided to research how pain management would make procedures more successful, or faster, to convince doctors to use pain management for THEIR benefit. MedicalResearch.com: What is the background for the Buzzy(r) device? How does it impact pain sensation? Response: When my 4 year old had a horrible vaccination experience, I realized that a fast effective parent-controlled option for pain relief was needed. I knew that cold running water could eliminate the pain from a burned finger using physiology called gate control. Basically, the small pain nerves run alongside big motion nerves, so if you heavily stimulate motion you scramble the pain sensation. Rubbing a bumped elbow is another good example. Vibration alone didn't work enough for needles, but when I added ice the two sensations of cold and motion eliminated pain in 84% of seniors getting a flu shot. We got a grant from the NIH to develop and study Buzzy - it's a palm sized vibration unit with a place on the back to attach ice "wings", that freeze solid. You put them both where an injection will go for a minute or less, then move them "between the brain and the pain" while doing a needle procedure. There are about 14 studies on IV access or blood draws and 6 on injections, showing between 50 and 88% pain reduction. Several studies have demonstrated that Buzzy is truly a physiologic intervention, not a distraction: it didn't work for injections when only used for 10 seconds, too little time to block the pain nerves. But it worked really well for blood draws in severely cognitively impaired children for whom distraction wasn't an option. (more…)
Author Interviews, Exercise - Fitness, Pain Research / 15.07.2016

MedicalResearch.com Interview with: Romy Lauche, PhD Chancellor’s Postdoctoral Research Fellow Australian Research Centre in Complementary and Integrative Medicine (ARCCIM) Faculty of Health | University of Technology Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Response: Many people are affected by persistent or recurrent neck pain. So far the only intervention with real benefit is exercise therapy, independent of the type of exercise used. Despite the fact that musculoskeletal disorders including back and neck pain have been found predictive of Tai Chi use, no study to date has investigated its potential in the treatment of chronic non-specific neck pain. Our study found that 12 weeks of Tai Chi significantly reduced neck pain intensity, and improved quality of life, however no differences were found between Tai Chi and conventional neck exercises. Both interventions were well tolerated, and participants were satisfied with either intervention. (more…)
Author Interviews, Genetic Research, Opiods, Pain Research, Thromboembolism / 14.07.2016

MedicalResearch.com Interview with: Brian Meshkin Founder and CEO of Proove Biosciences Editor’s note: Proove Biosciences, Inc introduced three new evidence-based tests to support better clinical decision-making for difficult-to-treat conditions that are influenced by genetics. These conditions include substance abuse, fibromyalgia and venous thromboembolism. The tests are especially relevant in light of the House of Representatives passing the Comprehensive Addiction Recovery Act (CARA) bill on July 8, 2016 to combat the opioid epidemic. MedicalResearch.com: Would you update our readers on the significance and implications of the CARA Act? What is the role of genetics in addiction? What is the background for the Proove Addiction™ Profile? How does it aid in addiction management? Response: CARA is a national piece of legislation to expand access to treatment for drug overdoses and addiction. It also includes some other provisions meant to help address the opioid epidemic. However, there are some serious implications. First, it does not contain any funding, so it is a bit of a “Potemkin Village”. It is also a bit of a façade because it does not address 50% of the equation. According to the definition of addiction from the American Society of Addiction Medicine (ASAM) and the National Institutes of Drug Abuse (NIDA), about half of substance abuse is due to genetic factors. If you are studying for a test and ignoring half of the material, chances are you are not going to do well on the test. As doctors are confronted with the challenges of objectively assessing pain and knowing which patients are at risk for abuse, they must consider genetics. The Proove Opioid Risk test combines genetic markers and phenotypic variables into an algorithm to effectively identify patients at low, moderate and high risk for opioid abuse. By knowing this information, a physician can make better decisions about opioids. For low risk patients, a physician can safely prescribe and a patient does not need to fear the opioid prescription they are given – as this is about 50% of the population. For those at moderate risk, a physician can use a greater level of vigilance to monitor those patients with abuse-deterrent formulations, regular urine drug screens, opioid contracts, and other tools to monitor their use. For the small number of patients – less than 10% - that are at high risk, a physician can use alternative forms of pain relief such as interventional procedures or non-opioid analgesics to provide the needed relief to patients. The Proove Addiction Profile builds on this commitment, by providing genetic data points related to other disorders, such as addictions to alcohol, heroin, cocaine and others. Unfortunately, many patients who screen positive for aberrant behavior, such as having an illicit drug in their urine, are often discharged from care by their doctor. This just gets them lost in the system. By running the Proove Addiction Profile in addition to a urine drug screen, a doctor can better understand the genetic factors associated with the aberrant behavior and refer the troubled patient to an addiction specialist for treatment. (more…)
Author Interviews, Breast Cancer, CMAJ, Pain Research / 13.07.2016

MedicalResearch.com Interview with: Jason Busse PhD Department of Anesthesia Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton, ON MedicalResearch.com: What is the background for this study? What are the main findings? Response: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. We found that development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection increases the absolute risk of persistent pain by 21%, and provides the only high yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery. (more…)
Author Interviews, Emergency Care, Neurological Disorders, NYU, Pain Research / 30.06.2016

MedicalResearch.com Interview with: Mia Minen, MD, MPH Assistant Professor of Neurology NYU Langone Medical Center MedicalResearch.com Editor’s note: The American Headache Society has issued new guidelines on “The Management of Adults With Acute Migraine in the Emergency Department” (1,2) Dr. Minen, Director of Headache Services at NYU Langone Medical Center, discusses these new guidelines below. MedicalResearch.com: What is the background for these new guidelines? How common/severe is the issue of migraine or headache presentation to the ER? Dr. Minen: These guidelines were needed because previous research shows that there are about 1.2. million visits to the emergency department (ED) each year for migraine, and over 25 different medications are sometimes used for treatment. Many of these medications don’t have evidence-based data to back their usage, and opioids are especially likely to be prescribed in between 60 and 70 percent of these cases, despite their lack of efficacy and risks. The American Headache Society convened an expert panel to review the existing evidence on all the medications used to treat migraines in the ED, and we developed these new treatment guidelines. (more…)
Author Interviews, BMJ, Pain Research / 21.06.2016

MedicalResearch.com Interview with: Dr Alan Fayaz MA MBBS MRCP FRCA FFPMRCA Consultant in Anaesthesia and Pain Medicine University College London Hospital NHS Foundation Trust MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Fayaz: Despite fairly well established negative consequences of chronic pain (social, psychological, biological) very little is known about the burden of chronic pain in the United Kingdom. For example healthcare costs relating to chronic pain in the USA outstrip those of Cancer and Cardiovascular disease, and yet the profile of chronic pain (as disease in its own right) is not nearly as well established as either of those conditions. Surprisingly, prior to our study, there was little consensus regarding the prevalence of chronic pain in the UK. The purpose of our review was to synthesise existing data on the prevalence of various chronic pain phenotypes, in the United Kingdom, in order to produce accurate and contemporary national estimates. (more…)
Author Interviews, Biomarkers, Pain Research / 13.06.2016

MedicalResearch.com Interview with: Dr. Gretchen Tietjen MD Professor and Chair of Neurology Director of UTMC Headache Treatment and Research Program Director of the UTMC Stroke Program MedicalResearch.com: What is the background for this study? Dr. Tietjen : C-reactive protein (CRP) is a well-established biomarker of inflammation. Elevated levels of CRP predict future cardiovascular events, such as myocardial infarction (heart attack) and stroke. Evidence linking higher CRP levels with migraine is limited and results from large population-based studies are conflicting. The National Health and Nutrition Examination Survey (NHANES) data for children and adolescents linked elevated CRP to headache, particularly in girls, and the Women’s Health Study showed an association of CRP with migraine in women over 45 years of age. In the Reykjavik study, CRP levels in persons with migraine were similar to levels in those without migraine. The aim of our study was to examine the relationship of CRP and migraine in a large population-based sample of over 9,000 young adults (24 to 32 years old) from The National Longitudinal Study of Adolescent to Adult Health (Add Health). (more…)
Author Interviews, CMAJ, Neurological Disorders, Pain Research / 07.06.2016

MedicalResearch.com Interview with: Dr Vincent Chung Assistant Professor, Jockey Club School of Public Health and Primary Care Associate Director (Education), Hong Kong Institute of Integrative Medicine Registered Chinese Medicine Practitioner The Chinese University of Hong Kong MedicalResearch.com: What is the background for this study? Response: Primary carpal tunnel syndrome (CTS) is one of the most common forms of peripheral entrapment neuropathy. It is a major cause of disability on the upper extremity incurring considerable limitation on daily activities among patients. Currently, there is no consensus on appropriate treatment for patients with chronic (≥6 months) mild to moderate symptoms [Archives of physical medicine and rehabilitation. 2014;95(12):2253-63]. Electroacupuncture is a common technique for managing pain and neuropathy in Chinese medicine. Current CTS treatment guidelines from the UK National Institute for Health and Care Excellence (NICE), American Academy of Orthopaedic Surgeons (AAOS) and the American College of Occupational and Environmental Medicine (ACOEM) made no specific recommendations for or against electroacupuncture. (more…)
Anesthesiology, Author Interviews, Breast Cancer, Opiods, Pain Research / 04.06.2016

MedicalResearch.com Interview with: Dr. Sarah Saxena Université Libre de Bruxelles MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Saxena: Opioids are well known analgesics, but like every drug, they do not come without side-effects. Recently, certain studies have been published about an opioid-free approach in bariatric patients. An opioid free approach is possible combining ketamine, lidocaine and clonidine. We studied this type of approach in breast cancer patients and looked at several factors such as patient comfort pain quality after an opioid free approach vs after an opioid approach. The study showed patients requiring less analgesics after an opioid free approach. (more…)