MedicalResearch.com Interview with: R Chris Williams PhD
Honorary Fellow, Musculoskeletal Division
The George Institute for Global Health
Sydney NSW 2000 Australia
Medical Research: What are the main findings of the study?Dr. Williams:We found that in addition to advice and reassurance, ‘regular’ or ‘as needed’ paracetamol did not improve recovery time for people with low back pain, compared to placebo. We also found the pain intensity and a range of other relevant measures, such as patient’s physical function was not different between the treatment groups.
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MedicalResearch.com Interview with: Kurt Kroenke, M.D.
Professor of Medicine, Indiana University School of Medicine
Research Scientist, Indiana University Center for Health Services and Outcomes Research
Research Scientist, Center for Health Services Research, Regenstrief Institute, Inc.
Director of Education and Training Programs, Regenstrief Institute, Inc.
Core Investigator, VA HSR&D Center for Health Information and Communication
Medical Research: What are the main findings of the study?
Dr. Kroenke: The telecare intervention including monitoring of pain using automated phone calls or the Internet with contacts by a nurse care manager who met weekly with a physician pain specialist to discuss treatment of new patients or patients already being followed who were not improving.
Almost twice as many patients in the telecare group had improvement in their pain compared to the usual care control group (52% vs. 27%).
Moreover, nearly twice as many patients in the usual care group got worse over 12 months (36% vs. 19%). Thus, patients with chronic pain may not only fail to improve with current treatment, they in fact can get worse over time.
Although one-third of these chronic pain patients were on opioids at start of study, there were very few patients in which opioids needed to be started or dose increased.
The intervention group was about equally divided between those who chose to do automated symptom monitoring (ASM) by IVR (51%) or internet (49%). The majority of patients rated the monitoring as easy to do, and the telecare intervention helpful.
MedicalResearch.com Interview with: William D. Chey, MD, AGAF, FACG, FACP, RFF
Professor of Medicine
Director, GI Physiology Laboratory
Co-director, Michigan Bowel Control Program
University of Michigan Health System
MedicalResearch: What are the main findings of the study?Dr. Chey: Opiate analgesics are the most commonly prescribed medications in the US. GI side effects are common in patients who opiates. Constipation is the most common and most bothersome GI side effect of opiates. Peripherally acting mu opioid antagonists have been shown to benefit a subset of patients with opiate induced constipation. In 2 large, randomized, placebo controlled phase III trials, the peripherally acting, mu-opioid antagonist naloxegol was found to improve constipation in patients taking opioid analgesics for noncancer pain. Response rates were significantly higher with 25 mg of naloxegol than with placebo (intention-to-treat population: study 04, 44.4% vs. 29.4%, P = 0.001; study 05, 39.7% vs. 29.3%, P = 0.02) in both studies. Benefits were seen with the lower 12.5 mg dose in one of the studies (intention-to-treat population, 40.8% vs. 29.4%, P = 0.02). An interesting aspect of this study was the a priori inclusion of patients who had tried and failed to respond to other laxatives prior to enrollment. Response rates in this population were similar to the overall population (patients with an inadequate response to laxatives: study 04, 48.7% vs. 28.8%, P = 0.002; study 05, 46.8% vs. 31.4%, P = 0.01). Pain scores and daily opioid dosing were similar among the three groups before and after treatment.
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MedicalResearch.com Interview with:Seok-Yong Lee, Ph.D.
Assistant Professor of Biochemistry and
Ru-Rong Ji, Ph.D.
Distinguished Professor of Duke University
Professor of Anesthesiology and Neurobiology
Chief of Pain Research
Duke University Medical Center
Durham, NC 27710
MedicalResearch: What are the main findings of the study? Answer:We have developed an antibody that can block the pain and itching sensations in mice simultaneously with high efficacy. We would like to point out that our discovery has the potential to be applied to human once the antibody is humanized. Given the high selectivity, general safety profile, and long half-lives of monoclonal antibodies, this method we developed to raise antibodies against therapeutic targets (e.g., ion channels) can have broad applications to other diseases.
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MedicalResearch Interview with:Dr. Teshamae Monteith MD
Assistant professor of Neurology
Chief of the Headache Division
University of Miami Miller School of Medicine.
MedicalResearch: What are the main findings of the study? Dr. Monteith:
A doubling of silent brain infarctions in those with migraine even after adjusting for other stroke risk factors;
No increase in the volume of white-matter hyperintensities (small blood vessel abnormalities) that have been associated with migraine in other studies;
Migraines with aura — changes in vision or other senses preceding the headache — wasn’t common in participants and wasn’t necessary for the association with silent cerebral infarctions.
High blood pressure, another important stroke risk factor, was more common in those with migraine. But the association between migraine and silent brain infarction was also found in participants with normal blood pressure.
MedicalResearch.com Interview with: Judy C. Boughey, MD
Chair, Division of Surgery Research
Mayo Clinic, Rochester, Minn.
MedicalResearch.com: What are the main findings of the study?Dr. Boughey: Use of paravertebral block (a form of regional anesthesia) in women undergoing mastectomy results in less need for opioid medications and less frequent use of anti-nausea medication after surgery.
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MedicalResearch.com Interview with:Dr. Juliane Bingener-Casey, M.D.
Mayo Clinic in Rochester, Minn.
MedicalResearch.com: What are the study’s main findings?Dr. Bingener-Casey: “Patient-reported outcomes such as pain and fatigue are sensitive tools to detect how well patients recover from surgery. These patient-reported outcome results are different for men and women and for older versus younger people.”
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MedicalResearch.com Interview with:Dr Damian Hoy
University of Queensland
School of Population Health
Herston, Australia
MedicalResearch.com: What are the main findings of the study?Dr. Hoy: The study was part of the Global Burden of Disease 2010 study, which was conducted by the University of Queensland, Harvard University, Johns Hopkins University, University of Washington, and hundreds of disease experts throughout the globe. It is the largest ever public health study. It compared the overall burden (in terms of both death and disability) of the most common 291 diseases/conditions in the world. Low back pain was found to cause more global disability than any other disease/condition. If this is something you are going through, it may be worth knowing that marijuana strains for back pain is one of the most powerful remedies. You've possibly tried everything in the shop and over the counter medicine. So why not give this a go and see how you get on. There's no harm in trying.
Global disability from low back pain is increasing. There is an urgent need for global, regional and national agencies to pay far greater attention to the disability caused by low back pain. In the developed world there are low back pain therapy treatments available whereas, in the developing world things aren't as accessible.
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MedicalResearch.com Interview Invitation with:Dr. Brian C. Callaghan MD
Department of Neurology
University of Michigan Health System, Ann Arbor
MedicalResearch.com: What are the main findings of the study?Dr. Callaghan: The main findings are that we order headache neuroimaging (MRIs and CTs) frequently, this accounts for approximately $1 billion dollars annually, and the number of tests ordered is only increasing with time.
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MedicalResearch.com Interview with: Maryann Mazer-Amirshahi PharmD, MD
The Department of Emergency Medicine, The George Washington University
The Department of Clinical Pharmacology, Children's National Medical Center, Washington, DC
MedicalResearch.com: What are the main findings of the study?Answer:We found a significant increase in the prescribing of opioid pain medications in the emergency department. At the same time, this was not accounted for by a similar increase in pain-related visits and prescribing patterns of non-opioid analgesics did not change.
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MedicalResearch.com Interview:Dr. John McBeth
Arthritis Research UK Primary Care Centre
Keele University in Staffordshire
MedicalResearch.com: What are the main findings of the study?Dr. McBeth: In this study, reporting musculoskeletal pain was common with just under half of participants reporting some pain and one quarter reporting widespread pain. Of those who were free of WP at baseline, 19% reported new onset widespread pain at three year follow up.
In addition to osteoarthritis, sleep, cognitive impairment, anxiety and physical health independently predicted the onset of widespread pain and are important treatment targets. In this study non-restorative sleep was the strongest predictor of new onset widespread pain. Sleep is a modifiable target that could improve outcome in this patient group.
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MedicalResearch.com Interview with:Fengmin Zhao, MS,PhD Biostatistician
Department of Biostatistics & Computational Biology Dana-Farber Cancer Institute
Boston, MA 02215
MedicalResearch.com: What are the main findings of the study?Dr. Zhao: We analyzed 2,761 patients in this study. We found that at initial assessment, 53.0% of patients had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase. Inadequate pain management was significantly associated with pain deterioration in these patients, as were lower baseline pain level, younger age, and poor health status. Of the patients without pain at initial assessment, 28.4% reported pain at the follow-up assessment (8.9% of them were moderate to severe pain), and more than half of them received inadequate pain management.
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MedicalResearch.com Interview with:Madhav Goyal MD, MPH
Assistant Professor
General Internal Medicine
Johns Hopkins School of Medicine
MedicalResearch.com: What are the main findings of the study?Dr. Goyal:
The evidence is moderately strong that there is a small but consistent benefit for mindfulness meditation programs to improve 3 symptoms: anxiety, depression, and pain. We found low level evidence that mindfulness meditation helps with symptoms of stress and distress, as well as with the mental health dimension of quality of life.
For the symptoms of anxiety and depression for which we find moderate evidence of benefit, we need to keep in mind that most of the trials didn't study people with a clinical diagnosis of anxiety or depression (although a few did). Most were studying diverse patient populations who may have had a low level of these symptoms, such as those with breast cancer, fibromyalgia, organ transplant recipients, and caregivers of people with dementia.
We found about a 5-10% improvement in anxiety symptoms compared to placebo groups. For depression, we found a roughly 10-20% improvement in depressive symptoms compared to the placebo groups. This is similar to the effects that other studies have found for the use of antidepressants in similar populations.
While we found that the evidence was moderately strong that mindfulness meditation programs may improve pain, there weren't as many trials evaluating chronic pain, and so we don't understand what kinds of pain this type of meditation may be most useful for.
MedicalResearch.com Interview with:Scott W. Powers, PhD APBB
Division of Behavioral Medicine and Clinical Psychology and
Division of Neurology, Cincinnati Children’s Hospital Medical Center Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
MedicalResearch.com: What are the main findings of the study?Dr. Powers: Cognitive behavioral therapy plus amitriptyline resulted in greater reductions in days with headache and migraine-related disability compared with the use of headache education plus amitriptyline. Children and adolescents with chronic migraine began the study with an average of 21 days with headache per 28 days and disability measured in the severe range. After 20 weeks of treatment, 2 out of 3 participants in the CBT group had a 50% or greater reduction in headache days and 3 out of 4 had a reduction in disability to the mild to none range.
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MedicalResearch.com Interview with:Dr. Morten Sejer Hansen
Department of Anaesthesia 4231
Centre of Head and Orthopaedics, Rigshospitalet
Copenhagen University Hospital, Copenhagen, Denmark
MedicalResearch.com: What are the main findings of the study?Answer: Out-of-hospital administration of intranasal fentanyl in doses of 50 and 100 microgram appears to be safe and well tolerated, with a low incidence of side effects
Secondly, intranasal fentanyl appeared effective in a wide range of patients, although no firm conclusions on analgesic efficacy can be provided due to the lack of a placebo control.
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MedicalResearch.com Interview with: Chad M. Brummett, M.D.
Assistant Professor, University of Michigan Health System
Department of Anesthesiology
Division of Pain Medicine
1500 East Medical Center Drive, 1H247 UH, Box 5048
Ann Arbor, MI 48109
MedicalResearch.com: What are the main findings of the study?Dr. Brummett: The study found that 42% of new patients presenting to a tertiary care pain clinic with a primary spine pain diagnosis met the American College of Rheumatology (ACR) survey criteria for fibromyalgia, which is a measure of widespread body pain and comorbid symptoms (e.g. trouble thinking, fatigue, mood symptoms, etc.). Patients categorized as fibromyalgia-positive using the survey measure were distinctly different from those not meeting criteria. In a multivariate regression model, independent predictors of being categorized as fibromyalgia-positive were female sex, higher neuropathic pain scores, anxiety, and lower physical function.
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Matthew Daubresse, MHS Research Data Analyst
Center for Drug Safety and Effectiveness
Johns Hopkins School of Public Health
615 N. Wolfe Street, Suite W6023
Baltimore, MD 21205
MedicalResearch.com: What are the main findings of the study?Answer: Over the past decade, prescriptions for non-opioid medications remained stable or declined among ambulatory pain visits in the United States. In visits for new-onset musculoskeletal pain, non-opioid prescribing decreased from 38% of visits in 2000 to 29% of visits in 2010. During this time, opioid prescriptions nearly doubled. Few patient, provider, and visit characteristics were associated with the likelihood of opioid receipt, suggesting increases in opioid prescribing have occurred generally across different groups of patients. (more…)
MedicalResearch.com Interview with:Conor P. Delaney, MD MCh PhD FRCSI FACS FASCRS
The Jeffrey L. Ponsky Professor of Surgical Education | Chief, Division of Colorectal Surgery | Vice-Chair, Department of Surgery | Director, CWRU Center for Skills and Simulation | Surgical Director, Digestive Health Institute | University Hospitals Case Medical Center | Case Western Reserve University | 11100 Euclid Avenue Cleveland, OH 44106-5047
MedicalResearch.com: What are the main findings of the study?Answer: Our goal was to see whether the transversus abdominis plane (TAP) block reduced complications and shortened the hospital stay of patients undergoing colorectal operations. The TAP block is a nerve block injection given at the conclusion of the operation which reduces pain in the operative area. Results showed that the mean hospital stay dropped to less than 2.5 days after the surgical procedure, significantly lower than the 3.7 days which the University Hospitals Case Medical Center Care pathway had already described for more than 1,000 consecutive patients. In our new study, we employed the TAP block and the Enhanced Recovery Pathway (ERP) on 100 patients. We found that 27 patients went home the next day and another 35 went home 48 hours after their operations. That is considerably better than the five or six days patients usually stay in the hospital after laparoscopic colorectal procedures, and certainly better than nine days often seen after an open operation. With a third of patients leaving the day after colorectal resection, we feel these results are significant.
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MedicalResearch.com Interview with: Jelle Vehof PhD
Department of Twin Research & Genetic Epidemiology
King’s College London, St Thomas’ Hospital, Waterloo, London, England
Department of Ophthalmology & Epidemiology
University Medical Center Groningen, Groningen, the Netherlands
MedicalResearch.com: What are the main findings of the study?Dr. Vehof: The current study provides the first empirical evidence that individuals with dry eye disease show altered pain sensitivity. Specifically, this study demonstrates that subjects with DED pain and discomfort complaints have lower pain threshold and pain tolerance of heat-based stimulus compared to those without.
These findings support the hypothesis that a subset of persons with DED is more sensitive to pain.
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MedicalResearch.com Interview with: Ru-Rong Ji, PhD
Professor, Chief of Pain Research
Department of Anesthesiology and Neurobiology
Duke University Medical Center
Durham, NC 27710
Neuroprotectin/Protectin D1 protects neuropathic pain in mice after nerve trauma
MedicalResearch.com: What are the main findings of the study?Answer: We found the pro-resolution lipid mediator protectin D1 (PD1), derived from the fish oil DHA, can effectively prevent nerve injury-induced neuropathic pain. This treatment can also prevent nerve injury-induced neuroinflammation in the spinal cord (such as glial activation and expression of cytokines and chemokines, e.g., IL-1b, CCL2). These cytokines and chemokines are known to elicit pain.
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MedicalResearch.com Interview with: Ru-Rong Ji, PhD
Professor, Chief of Pain Research
Department of Anesthesiology and Neurobiology
Duke University Medical Center
Box DUMC 3094, Durham , NC 27710
MedicalResearch.com: What are the main findings of the study?Answer: We found the pro-resolution lipid mediator protectin D1 (PD1), derived from the fish oil DHA, can effectively prevent nerve injury-induced neuropathic pain. This treatment can also prevent nerve injury-induced neuroinflammation in the spinal cord (such as glial activation and expression of cytokines and chemokines, e.g., IL-1b, CCL2). These cytokines and chemokines are known to elicit pain.
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