Pain Research

16 Feb

Posted at 01:34h in Author Interviews, Inflammation, JAMA, Kidney Disease, Pain Research, Stanford
MedicalResearch.com Interview with: Alan Nelson, MPAS, PhD Division of Primary Care and Population Health, Department of Medicine Stanford University School of Medicine Stanford, California  MedicalResearch.com: What is the background for this study?   Response: The past research literature has provided relatively little information on the appropriate level of concern regarding non-steroidal anti-inflammatory drugs (NSAIDs) and kidney disease risk among younger, apparently healthy patients. Clinicians are generally most concerned about the effects of these medications on the kidneys among patients with existing renal impairment and persons at risk for it, especially older patients. Given that NSAID use appears to be high and rising in the US, we were interested in developing evidence on this topic in a population of working-age adults.

04 Feb

Posted at 20:45h in Author Interviews, Pain Research, Stroke
MedicalResearch.com Interview with [caption id="attachment_47315" align="alignleft" width="160"]Michelle Androulakis, MD, MS, FAHS Chief of Neurology WJB Dorn VA Medical Center and Faculty at University of South Carolina. Columbia, SC Dr. Androulakis[/caption] Michelle Androulakis, MD, MS, FAHS Chief of Neurology WJB Dorn VA Medical Center and Faculty at University of South Carolina. Columbia, SC MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Even though Migraine with aura was associated with an increased risk of ischemic stroke in the Atherosclerosis Risk in Communities study (ARIC), our post-hoc showed unexpected results that onset of such migraines before age 50 years is not associated with such risk. Instead, later onset of migraine with aura after age of 50 was linked with a higher risk of ischemic stroke. Total of 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 participants were included in the analysis. There was a two-fold increased risk of ischemic stroke when the age of migraineurs with aura onset was 50 years or older as compared with no headache participants, MO was not associated with increased stroke risk regardless of age of onset. 

09 Jan

Posted at 15:25h in Author Interviews, C. difficile, Microbiome, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_46859" align="alignleft" width="133"]MedicalResearch.com Interview with: David M. Aronoff, MD, FIDSA, FAAM Professor & Addison B. Scoville Jr. Chair in Medicine Director, Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Clostridium difficile infection (CDI) is a major cause of antibiotic-associated colitis and diarrhea and a leading cause of hospital-acquired infection. It is caused by the toxin-producing, anaerobic, spore-forming bacterium Clostridium difficile. Antibiotic use is a major risk factor for CDI but epidemiological studies suggest that other factors, some modifiable, some not, can also increase the risk for CDI. Older age is an example of a non-modifiable risk factor for CDI. Some epidemiological studies suggested that taking the prostaglandin synthesis inhibiting drugs called non-steroidal anti-inflammatory drugs (NSAIDs) might also increase the risk for CDI. NSAIDs include medications such as ibuprofen, naproxen, indomethacin, and others. Because NSAID use is so common, if it is a risk factor for the acquisition of, or severity of, CDI, that would be important because that would be a modifiable risk factor. We therefore sought to determine the impact of NSAID exposure on CDI severity in a mouse model of antibiotic-associated CDI. We also sought evidence for possible mechanisms whereby NSAIDs might increase the risk for CDI. MedicalResearch.com: What are the main findings? Response: Exposure of mice to indomethacin (an NSAID) for two days prior to infection with Clostridium difficile in antibiotic-exposed mice increased the severity of disease and this was associated with severe inflammation, changes to the bacterial populations in the colon and increased damage to the protective epithelial lining of the colon. MedicalResearch.com: What should readers take away from your report? Response: Our studies provide evidence in a mouse model of CDI that support human epidemiological studies linking NSAID use with CDI. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Studies in humans are needed to see if NSAID use is indeed a causal risk factor for CDI acquisition or severity. MedicalResearch.com: Is there anything else you would like to add? Response: This work was funded by the National Institutes of Health and the Crohn’s and Colitis Foundation of America. Dr. Aronoff has served as Consultant for Synthetic Biologics, Inc, Biocidium, NAEJA-RGM and BLC-USA on projects unrelated to this study. He also has research funding from Pfizer unrelated to this study. Citation: Damian Maseda, Joseph P. Zackular, Bruno Trindade, Leslie Kirk, Jennifer Lising Roxas, Lisa M. Rogers, Mary K. Washington, Liping Du, Tatsuki Koyama, V. K. Viswanathan, Gayatri Vedantam, Patrick D. Schloss, Leslie J. Crofford, Eric P. Skaar, David M. Aronoff. Nonsteroidal Anti-inflammatory Drugs Alter the Microbiota and Exacerbate Clostridium difficile Colitis while Dysregulating the Inflammatory Response. mBio, 2019; 10 (1) DOI: 10.1128/mBio.02282-18 [wysija_form id="3"] [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. Dr. Aronoff[/caption]David M. Aronoff, MD, FIDSA, FAAM Professor & Addison B. Scoville Jr. Chair in Medicine Director, Division of Infectious Diseases Department of Medicine Vanderbilt University Medical Center MedicalResearch.com: What is the background for this study? Response: Clostridium difficile infection (CDI) is a major cause of antibiotic-associated colitis and diarrhea and a leading cause of hospital-acquired infection. It is caused by the toxin-producing, anaerobic, spore-forming bacterium Clostridium difficile. Antibiotic use is a major risk factor for CDI but epidemiological studies suggest that other factors, some modifiable, some not, can also increase the risk for CDI. Older age is an example of a non-modifiable risk factor for CDI. Some epidemiological studies suggested that taking the prostaglandin synthesis inhibiting drugs called non-steroidal anti-inflammatory drugs (NSAIDs) might also increase the risk for CDI. NSAIDs include medications such as ibuprofen, naproxen, indomethacin, and others. Because NSAID use is so common, if it is a risk factor for the acquisition of, or severity of, CDI, that would be important because that would be a modifiable risk factor. We therefore sought to determine the impact of NSAID exposure on CDI severity in a mouse model of antibiotic-associated CDI. We also sought evidence for possible mechanisms whereby NSAIDs might increase the risk for CDI.

09 Jan

Posted at 00:04h in Author Interviews, JAMA, Orthopedics, Pain Research, University of Pittsburgh
MedicalResearch.com Interview with: [caption id="attachment_46849" align="alignleft" width="200"]Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh Dr. Schneider[/caption] Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient. We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 

17 Dec

Posted at 23:47h in Author Interviews, Diabetes, JAMA, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_46571" align="alignleft" width="200"]Guy Fagherazzi, MSc, PhD, HDR Senior Research Scientist in Digital & Diabetes Epidemiology Center of Research in Epidemiology and Population Health  Inserm, Paris-South Paris-Saclay University Dr. Guy Fagherazzi[/caption] Guy Fagherazzi, MSc, PhD, HDR Senior Research Scientist in Digital & Diabetes Epidemiology Center of Research in Epidemiology and Population Health Inserm, Paris-South Paris-Saclay University MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Migraine has further been associated with increased risk of overall and specific cardiovascular disease events. Because migraine has also been associated with factors related with insulin resistance and type 2 diabetes, an association between migraine and diabetes has been hypothesized. We observed a lower risk of type 2 diabetes in women with active migraine. We also show a linear decrease of migraine prevalence long before and a plateau long after type 2 diabetes diagnosis. 

28 Nov

Posted at 12:06h in Author Interviews, CT Scanning, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_46235" align="alignleft" width="300"]Probe being applied to nerve root. Credit: Radiological Society of North America Probe being applied to nerve root.
Credit: Radiological Society of North America[/caption] Alessandro Napoli MD PhD Department of Radiological, Oncological and Pathological Sciences Sapienza University of Rome  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Disc Herniation in the lumbar region can create intense pain in the lower back and along the leg as a result of nerve compression. People suffering disc herniation may either experience a spontaneous relief from the pain or requiring further medical actions in order to improve quality of life and going back to work and daily activities. When the pain is not responding to usual conservative care (both physical and pharmacological therapy) surgery is often considered a valid option.However, most of the people (despite the intense pain) would possibly avoid surgery. For this reason, Interventional percutaneous therapies such as intraforaminal injection of steroid have become more popular. Pulsed radiofrequency is a percutaneous therapy that may have the potential to rapidly relief the pain in a long lasting way by means of single 10 minutes procedure. We decided to undertook a randomized clinical trial to test the clinical benefit of pulsed radiofrequency therapy using intraforaminal injection as a control group. in both groups percutaneous approach was guided under precise guidance of CT images. Pulsed radiofrequency group patients experience a faster and more durable pain control during the 1 year period follow up. Incidence of retreatment or cross-over was significantly higher in the injection only group.

13 Nov

Posted at 13:49h in Author Interviews, Exercise - Fitness, Pain Research
MedicalResearch.com Interview with: Ms Lynne Gaskell MSc University of Salford Manchester UK MedicalResearch.com: What is the background for this study? Response: Musculoskeletal Pain as a result of common problems affecting the back, neck, shoulder, knee and multi-site pain is an increasing cause of reduced function and quality of life, and ever increasing demands on healthcare, Prognosis is often poor with many people reporting persistent symptoms after consulting their primary care practitioner. The likelihood of persistent and recurrent clinical symptoms may accentuate the physical, psychological, and social impacts of musculoskeletal pain particularly with the middle aged and elderly populations. Pilates is an exercise approach that has become increasingly popular in recent years and includes over fifty different exercises to improve flexibility, balance, core strength, core stability. It can therefore can be individualised for people with different needs, preferences, musculoskeletal conditions, ages and abilities. Aligning exercise to patient’s functional needs has been linked to long-term exercise adherence. Many physiotherapists such as sydney physio solutions have started to specialise in this as a form of treatment, click here for more info on pilates and the many benefits they can have on your physical health. This study investigated the personal experiences and perceptions of the impact of Pilates on the day-to-day lives of adults with a myriad of chronic MSK conditions following a 12 week Pilates Exercise Programme.The results were organised into five main themes: 1. Physical Improvements strength, core stability, flexibility and balance. 2. Pilates Promotes an Active Lifestyle and improved performance at work and / or hobbies. 3. Psychosocial benefits and improved confidence, 4. Increased Autonomy in Managing their own Musculoskeletal Condition and 5. Motivation to continue with exercise.

29 Oct

Posted at 20:25h in Anesthesiology, Author Interviews, Opiods, Pain Research, Surgical Research
MedicalResearch.com Interview with: "Surgery" by Army Medicine is licensed under CC BY 2.0Dr. Nirmal B. Shah Anesthesia Resident PGY-IV (CA-III) Thomas Jefferson University Hospital MedicalResearch.com: What is the background for this study? What are the main findings?  Response: With the ongoing opioid epidemic, we believe it is important to understand patients’ perceptions of pain medications and pain control after surgery. We believe patients’ expectations and perceptions regarding perioperative pain medications has not been well understood. We were hoping to understand patients’ knowledge, concerns, and biases of pain medication along with information to optimize acute pain management. The goal of this survey study was to understand patient expectations regarding pain medications including opioids and non- opioids.  In the United States, over 100 million surgical procedures are performed every year. Nearly 80% of these patients will experience post-operative pain. Adequate treatment of post-operative pain has been shown to improve clinical and economic outcomes, thus there has been an increased effort towards improving post-operative pain control. Through our research, we demonstrated that patients expect to experience postoperative pain after a surgical procedure and expect to be prescribed a pain medication. Patients believe that opioid medications will be most effective in treating postoperative pain compared to non-opioid medications, which could be contributing to the opioid epidemic. 503 patients presenting for elective surgery at Thomas Jefferson University Hospital in Philadelphia, PA were sampled during this survey. 76% of patients expected to be prescribed an opioid pain medication at discharge, 47% of patients expected to be prescribed acetaminophen (Tylenol) pain medication at discharge, while 30% of patients expected to be prescribed an NSAID (Motrin) pain medication at discharge. 94% of patients expecting to receive an opioid pain medication believe it would be effective in controlling their post-operative pain. This difference was not observed in patients expecting prescriptions for non-opioid pain medications. Overall, patients expect to experience pain after surgery and be prescribed analgesics they perceived to be most effective, opioids.

17 Oct

Posted at 20:32h in Author Interviews, BMJ, Genetic Research, Pain Research, Pediatrics
MedicalResearch.com Interview with: "DNA model" by Caroline Davis2010 is licensed under CC BY 2.0Hakon Hakonarson, MD, PhD Corresponding Author Xiao Chang, PhD Lead Author The Center for Applied Genomics Children’s Hospital Philadelphia Philadelphia, Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings? Response: Migraine is a genetic disorder characterized by recurrent and intense headaches often accompanied by visual disturbances. Genome-wide association studies (GWASs) are a powerful hypothesis-free tool for investigating the genetic architecture of human disease. Currently, multiple GWASs have been conducted on European adults with migraine that have successfully identified several migraine susceptibility genes involved in neuronal and vascular functions. Considering the prevalence of migraines varies across ethnicities, the genetic risk factors may be different in patients of African ancestries and European ancestries. In addition, if migraine presents at an early age (childhood), it may reflect elevated biological predisposition from genetic factors or increased susceptibility to environmental risk factors. We performed the first GWAS to investigate the susceptibility genes associated with migraine in African-American children. The main out come was that common variants at the 5q33.1 locus in the human genome are associated with migraine risk in African-American children. The genetic underpinnings at this locus responsible for this finding are less relevant in patients of European ancestry. 

11 Oct

Posted at 17:05h in Author Interviews, MRI, Pain Research, Rheumatology
MedicalResearch.com Interview with: Daniel S. Albrecht, Ph.D. Research Fellow, Department of Radiology Harvard Medical School MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by fibromyalgia? Response: Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, unrefreshing sleep, memory deficits and attention difficulties, among other symptoms. FM affects an estimated 4 million adults in the U.S., but despite this prevalence, effective therapies for treating FM are lacking. [caption id="attachment_45185" align="aligncenter" width="400"]This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers. Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers.
Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital[/caption] Part of the reason for the paucity of effective therapeutics is insufficient knowledge of the underlying mechanisms contributing to FM. Previous work from co-senior author of the current manuscript, Eva Kosek, MD, PhD, and collaborators at the Karolinska Institute in Sweden found elevated inflammatory molecules in the cerebrospinal fluid of FM patients, which could be reflective of brain neuroinflammation in these patients. However, no study had directly assessed the presence of neuroinflammation in the brain of FM patients. Co-senior author of the study, Marco Loggia, PhD, and collaborators showed in a 2015 Brain publication that individuals with chronic low back pain (cLBP) exhibit evidence of brain neuroinflammation, specifically activation of glial cells. Our team utilized simultaneous MR/PET imaging to image brain levels of the 18 kDa translocator protein (TSPO), which is widely used as a marker of glial activation due to vast upregulation of TSPO in glial cells, e.g. microglia and astrocytes, in preclinical models of inflammation and neurological disease. Dr. Loggia sought to extend these finding in cLBP to FM, hypothesizing that activation of glial cells may also be associated with FM pathology. To this end, we used the same TSPO PET tracer to image 20 FM patients and 16 healthy controls. During a conference where I was presenting preliminary results of the fibromyalgia study, Dr. Loggia met with Dr. Kosek and discovered that, across the Atlantic, her group was performing a very similar study, imaging 11 FM patients and 11 controls with the same TSPO PET compound. They decided to form a collaboration, and logistic talks began to determine the best strategy to combine and analyze the separate datasets. In addition to PET imaging with the TSPO tracer, which is suggested to reflect activated microglia and astrocytes, Dr. Kosek’s group also collected PET scans using a tracer thought to bind specifically to astrocytes rather than microglia. This tracer was used in order to discern the relative contributions of microglia and astrocytes to any observed differences in TSPO PET signal.

25 Sep

Posted at 18:03h in Author Interviews, Neurology, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_44791" align="alignleft" width="172"]John Douglas Markman, M.D. Director, Translational Pain Research Program Department of Neurosurgery Associate Professor University of Rochester School of Medicine and Dentistry Dr. Markman[/caption] John Douglas Markman, M.D. Director, Translational Pain Research Program Department of Neurosurgery Professor University of Rochester School of Medicine and Dentistry  MedicalResearch.com: What is the background for this study? Response: Peripheral nerve injury after trauma and surgery is a leading cause of chronic pain and disability. These pain syndromes are often considered to have an underlying neuropathic mechanism because there is altered sensory processing (e.g., numbness, allodynia) at the site of trauma or surgical incision that localizes to the anatomic distribution of a peripheral nerve. A previous eight-week randomized clinical trial demonstrated efficacy for pregabalin in patients with chronic post-traumatic or -surgical pain.(10) The longer duration of treatment of this study was designed to meet the regulatory standard for a chronic pain indication in the US, 12 weeks of treatment at maintenance or fixed dosing.

20 Sep

Posted at 17:19h in Author Interviews, Cannabis, Pain Research
MedicalResearch.com Interview with: “Cannabis” by Don Goofy is licensed under CC BY 2.0Martin De Vita, MS Doctoral Candidate Clinical Psychology Department Syracuse University MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Despite widely held beliefs that cannabis is effective for pain relief, experimental trials have produced mixed results. As result, the analgesic properties of cannabinoid drugs have remained poorly understood. We aimed to clarify these findings by extracting data from every available experimental pain study and analyzing the results as a whole. We found that numerous aspects of pain were being influenced in different ways. We found that cannabinoid drugs did not significantly reduce the intensity of experimental pain, but they did produce small-sized reductions in pain unpleasantness. Cannabinoids produced significant analgesic effects on pain threshold and tolerance. There was no significant effect of cannabinoids on mechanical hyperalgesia.

13 Sep

Posted at 00:05h in Author Interviews, Cannabis, Pain Research
MedicalResearch.com Interview with: Jacob M. Vigil, PhD Department of Psychology University of New Mexico MedicalResearch.com: What is the background for this study?   Response: For the past several years we have been using observational research designs as a means to overcome some of the logistical and legal barriers for conducting patient outcomes medical cannabis research. In partnership with the software developers of the Releaf App which currently is the largest repository of user-entered information on the consumption and effects of cannabis use in the United States, we have been able to measure how patients choose to consume cannabis and the effects of those choices in real-time.  Since its release in 2016, the commercially developed Releaf App has been the only publicly available, incentive-free patient educational software program designed for recording how individual cannabis usage sessions correspond to immediate changes in symptom intensity levels and experienced side effects.

12 Sep

Posted at 19:23h in Author Interviews, Pain Research, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_44452" align="alignleft" width="148"]Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine Dr. Jonas[/caption] Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine MedicalResearch.com: What is the background for this study? Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

09 Sep

Posted at 18:29h in Author Interviews, JAMA, Pain Research, Surgical Research
MedicalResearch.com Interview with: [caption id="attachment_44355" align="alignleft" width="133"]David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  Dr. Shaye[/caption] David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids. In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons. Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills. We believe patients experienced less pain than surgeons anticipated.

06 Sep

Posted at 12:26h in Author Interviews, JAMA, Pain Research, Technology
MedicalResearch.com Interview with: [caption id="attachment_44273" align="alignleft" width="150"]Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento Dr. Kravitz[/caption] Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  The study was designed to address tso problems. The first is that many patients with chronic pain struggling to find a workable regimen. The second is more general. Patient sometimes I hesitate to participate in clinical research because they right away do not see the relevance I directly to them selves. And have one trials are away I’m addressing both problems. 

26 Jul

Posted at 19:23h in Abbvie, Author Interviews, OBGYNE, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_43518" align="alignleft" width="200"]Dr. Dawn Carlson MD MPH Vice President, General Medicine Development AbbVie  Dr. Carlson[/caption] Dr. Dawn Carlson MD MPH Vice President, General Medicine Development AbbVie  MedicalResearch.com: Please provide some background on this announcement. Would you briefly explain what endometriosis is? Whom does it affect and how does it interfere with quality of life? Response: Endometriosis is one of the most common gynecologic disorders in the U.S that affects an estimated one in 10 women of reproductive age. It occurs when tissue similar to the lining of the uterus starts growing outside of the uterus, where it doesn’t belong. The symptoms of endometriosis, including pain with menstrual periods and between periods, and with sexual intercourse, can be debilitating and significantly impact day-to-day activities of women’s lives, personally and professionally. Unfortunately, women with endometriosis can suffer for up to 10 years and visit multiple physicians before receiving a proper diagnosis. Unresolved endometriosis pain results in higher healthcare costs from emergency department visits and repeat surgeries. 

23 Jul

Posted at 11:09h in Addiction, Anesthesiology, Author Interviews, Emergency Care, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_43379" align="alignleft" width="120"]Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine Dr. Schwarz[/caption] Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department. Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED. In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.

17 Jul

Posted at 14:27h in Author Interviews, ENT, JAMA, Neurology, Pain Research

MedicalResearch.com Interview with: Jen-Tsung Lai, MD Department of Otolaryngology Kuang-Tien General Hospital Shalu, Taichung, Taiwan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cochlear Migraine( CM ) is a new proposed diagnosis in 2018. CM could present as fluctuating hearing loss or sudden hearing loss that provoked the tinnitus. Furthermore , CM with...

16 Jul

Posted at 17:38h in Author Interviews, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_42982" align="alignleft" width="133"]Dawn Hershman, MD, MS, FASCO Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center Dr. Hershman[/caption] Dawn Hershman, MD, MS, FASCO Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aromatase inhibitors are effective in reducing the risk of recurrence in hormone sensitive breast cancer, however they commonly cause joint pain and stiffness that can lead to early discontinuation of treatment. We know that women who stop early do not get the same benefits as those who continue for the full duration. Acupuncture has been shown to improve a variety of pain syndromes. We conducted a large multicenter trial among women with joint pain on aromatase inhibitors and randomized patients to true acupuncture, sham acupuncture and a waitlist control arm. We found that acupuncture resulted in more pain reduction than the other 2 control groups. Measuring pain can be challenging in clinical trials. We now know that a meaningful reduction for a patient is 2 points on a 10 point scale. We found that nearly 60 percent of women in the true acupuncture group experienced at least a 2-point reduction in pain, versus 33 percent of the sham acupuncture group and 31 percent of the controls. These results where highly statistically significant. 

19 Jun

Posted at 11:02h in Author Interviews, Pain Research, Rheumatology, Weight Research
MedicalResearch.com Interview with: [caption id="attachment_42538" align="alignleft" width="200"]Wake Forest professor of Health and Exercise Science Steve Messier, Friday, June 15, 2018. Prof. Messier[/caption] Professor Steve Messier Director of the J.B. Snow Biomechanics Laboratory J.B Snow Biomechanics Laboratory Wake Forest University MedicalResearch.com: Why did you undertake this study? Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273. We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial.

06 Jun

Posted at 12:33h in Author Interviews, Kidney Disease, Neurological Disorders, Pain Research, UCSF
MedicalResearch.com Interview with: [caption id="attachment_42216" align="alignleft" width="150"]Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center Dr. Ishida[/caption] Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population. Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population. 

04 Jun

Posted at 21:37h in Author Interviews, Pain Research, Pharmaceutical Companies
MedicalResearch.com Interview with: Zosano Pharma Dr. Peter Schmidt, MD, MSc Senior Director, medical Affairs and Clinical Development Zosano Pharma   MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was a post-hoc analysis of Zosano’s pivotal efficacy trial using its adhesive dermally-applied microarray (ADAM) zolmitriptan formulation, M207. The trial found that M207 was effective versus placebo for the co-primary endpoints of pain freedom and most bothersome symptom (MBS) freedom, both at two hours. The MBS endpoint was just ratified as a new endpoint in the FDA’s February 2018 guidance for acute migraine trials. The stated aim of this new endpoint is “…to better align the study outcome with the symptom(s) of primary importance to patients…” This is logical, as a given migraine patient may not experience all four previous symptom endpoints (pain, photophobia, phonophobia, nausea).

23 May

Posted at 16:31h in Addiction, Author Interviews, Opiods, Pain Research
MedicalResearch.com Interview with: [caption id="attachment_41977" align="alignleft" width="160"]Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig[/caption] Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic. MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study? Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention. The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.

21 May

Posted at 10:47h in Author Interviews, JAMA, Orthopedics, Pain Research
MedicalResearch.com Interview with: “Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD Vice Chancellor for Research and Health Policy Palmer College of Chiropractic MedicalResearch.com: What is the background for this study? Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel. Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military.

17 May

Posted at 15:07h in Author Interviews, Infections, Pain Research, PLoS, Urinary Tract Infections
MedicalResearch.com Interview with: [caption id="attachment_41792" align="alignleft" width="150"]Ingvild Vik MD Doctoral Research Fellow Department of General Practice Institute of Health and Society - UiO University of Oslo, Norway. Dr. Vik[/caption] Ingvild Vik MD Doctoral Research Fellow Department of General Practice Institute of Health and Society - UiO University of Oslo, Norway MedicalResearch.com: What is the background for this study? Response: Uncomplicated urinary tract infection (UTI) is the most common bacterial infection in women. It is painful and troublesome, and even though it is often self-limiting most women who see a doctor will be prescribed an antibiotic, as antibiotics provide quick symptom relief.  Antibiotic resistance is a growing, serious public health problem. Antibiotic use is the main contributor to antibiotic resistance, and to stop the rapid development it is crucial that we reduce unnecessary use of antibiotics. Antibiotics can cause unpleasant and potentially severe side effects, so avoiding unnecessary use is also beneficial for the individual patient. A small German trial published in 2010 by Bleidorn et al. suggested that ibuprofen was non-inferior to the antibiotic ciprofloxacin in achieving symptomatic cure in uncomplicated UTI. This inspired us to conduct a larger trial to compare the anti-inflammatory drug ibuprofen to antibiotics in the treatment of uncomplicated UTI. 

11 May

Posted at 17:50h in Author Interviews, Biomarkers, Brigham & Women's - Harvard, Orthopedics, Pain Research
MedicalResearch.com Interview with: “osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD Research Fellow in Radiology, Harvard Medical School Research Fellow, Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury. This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited. In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots. Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation. While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain. 

07 May

Posted at 23:34h in Author Interviews, JAMA, Pain Research, Psychological Science
MedicalResearch.com Interview with: [caption id="attachment_41491" align="alignleft" width="131"]Dr. M. Carrington Reid, MD PhD Associate Professor of Medicine Irving Sherwood Wright Associate Professor in Geriatrics Joachim Silbermann Family Clinical Scholar in Geriatric Palliative Care Joan and Sanford I. Weill Department of Medicine Weill Cornell Medical College  Dr. Reid[/caption] Dr. M. Carrington Reid, MD PhD Associate Professor of Medicine Irving Sherwood Wright Associate Professor in Geriatrics Joachim Silbermann Family Clinical Scholar Geriatric Palliative Care Joan and Sanford I. Weill Department of Medicine Weill Cornell Medical College MedicalResearch.com: What is the background for this study?   Response: Major guidelines (American College of Physicians, Centers for Disease Control, Veterans Administration) on the management of chronic pain strongly encourage clinicians to use nonpharmacologic approaches to include psychological therapies when managing pain. While many studies have evaluated psychological therapies such as cognitive behavioral theraphy (CBT) in nonelderly populations with chronic pain, far fewer have evaluated these treatments in studies of older adults. We identified 22 randomized controlled trials that evaluated a psychological therapy for chronic pain in older adults and examined the impact of these treatments on salient outcomes to include ability to reduce pain and pain-related disability, improve patients' self efficacy to manage pain, and improve their physical health and function and their psychological health (by reducing rates of anxiety and depression).