Author Interviews, OBGYNE, Pain Research / 04.03.2016

MedicalResearch.com Interview with: [caption id="attachment_22355" align="alignleft" width="120"]Matthew S. Robbins, MD, FAHS Associate Professor of Clinical Neurology, Albert Einstein College of Medicine Chief of Neurology, Jack D. Weiler Hospital, Montefiore Medical Center Director of Inpatient Services, Montefiore Headache Center Associate Program Director, Neurology Residency Dr. Matthew Robbins[/caption] Matthew S. Robbins, MD, FAHS Associate Professor of Clinical Neurology, Albert Einstein College of Medicine Chief of Neurology, Jack D. Weiler Hospital Montefiore Medical Center Director of Inpatient Services, Montefiore Headache Center Associate Program Director, Neurology Residency MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Robbins: It is now well-established that having a history of migraine increases the risk of having vascular and obstetrical complications for pregnant women.  What is not known is if having active migraine during pregnancy would increase complications later on in that very same pregnancy.  Having severe migraine attacks during pregnancy may indicate particularly severe and active disease.  We evaluated pregnant women who presented to the hospital setting with acute, severe migraine attacks, and then reviewed their records for what happened during the same pregnancy when they delivered.  We found that compared to local and national rates, pregnant women with severe migraine attacks presenting to the hospital have increased rates of preeclampsia, preterm delivery, and low birthweight.  This risk was particularly elevated in pregnant women age 35 years or older.
Author Interviews, Pain Research, Race/Ethnic Diversity / 24.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21957" align="alignleft" width="178"]Adam T. Hirsh PhD Assistant Professor, Psychology Indiana University Indianapolis, IN Dr. Adam T. Hirsh[/caption] Adam T. Hirsh PhD Assistant Professor, Psychology Indiana University Indianapolis, IN  Medical Research: What is the background for this study? What are the main findings? Dr. Hirsh: Pain is highly prevalent and is a major cause of disability. How patients cope with pain affects how much pain they feel and how much that pain interferes with their lives. Compared to White individuals, Black individuals experience greater pain across a number of clinical conditions, as well as in response to experimentally-delivered stimuli. These race differences may be due to differences in pain-related coping. We conducted a meta-analysis of clinical and experimental studies (including 2,719 Black and 3,770 White adults) to quantify race differences in the overall use of pain coping strategies as well as specific coping strategies. The results indicated that, compared to White individuals, Black individuals used pain coping strategies more frequently overall. In particular, Black individuals more frequently used strategies that involved praying and catastrophizing, whereas White individuals more frequently used strategies that involved task persistence. These results suggest that Black individuals use coping strategies more frequently, specifically strategies associated with poorer pain outcomes.
Author Interviews, Depression, Opiods, Pain Research / 19.02.2016

MedicalResearch.com Interview with: Dr-Jeffrey-ScherrerJeffrey F. Scherrer, PhD Associate Professor Research Director Department of Family and Community Medicine Saint Louis University School of Medicine St. Louis, MO 63104  Medical Research: What is the background for this study? What are the main findings? Dr. Scherrer: We initiated a series of studies on chronic opioid use and risk of depression about 3 years ago and obtained an NIH R21 to study prescription opioid use and risk of new onset depression, depression recurrence and transition to treatment resistant depression.  The rationale comes partly from clinical observations of the research team (I am not a clinician, just a epidemiologist).  We also observed the large field demonstrating patients with depression are more likely to get opioids for pain, take them longer and develop abuse.  We wanted to switch the direction of effect to determine if the reverse exists.  After publishing two papers demonstrating longer use of opioid was associated with increasing risk of depression, our next step was to look at recurrence among patients with a recent history of depression. Medical Research: What should clinicians and patients take away from your report? Dr. Scherrer: Our main recommendation is clinicians should repeatedly screen patients for depression.  While screening at time of starting opioids is common, repeated screening is worth consideration.  Patients with depression who may experience temporary euphoria should not expect opioids to cure depression and they may increase risk for worsening mood and or recurrence after long term use.
Author Interviews, Pain Research / 17.02.2016

MedicalResearch.com Interview with: [caption id="attachment_21710" align="alignleft" width="159"]Souvik Sen, MD, MS, MPH, FAHA Professor and Chair, Neurology Department, South Carolina Smart State Endowed Stroke Chair University of South Carolina School of Medicine Dr. Souvik Sen[/caption] Souvik Sen, MD, MS, MPH, FAHA Professor and Chair,  Neurology Department, South Carolina Smart State Endowed Stroke Chair University of South Carolina School of Medicine  Medical Research: What was the catalyst for conducting this study examining the association between migraine with aura and ischemic stroke subtypes? Dr. Souvik Sen: South Carolina, North Carolina, and Georgia are located in the “buckle” of the stroke belt, with one of the highest stroke related death rates in the country. An unfortunate trend is that younger patients are having strokes leading to death and disability. As a part of the workup for young stroke we are interested in migraine with aura and the type of stroke associated with this condition. Medical Research: What did you conclude as a result of the findings and how did they compare with your expectations at the beginning of the study?
Author Interviews, Menopause, Pain Research / 25.01.2016

[caption id="attachment_20903" align="alignleft" width="80"]Dr. Vincent Martin, MD Professor of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH Dr. Martin[/caption] MedicalResearch.com Interview with: Dr. Vincent Martin, MD Professor of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH Medical Research: What is the background for this study? What are the main findings? Dr. Martin: Past studies have found that the perimenopause is associated with an increased prevalence of migraine headache, but there have been no studies to determine if the frequency of migraine attacks is increased during this time period.  In our study we reported that high frequency headache (≥10 days per month with headache) was increased by 62% during perimenopause (irregular menstrual cycles) as compared to premenopause (regular menstrual cycles).  We later divided the perimenopause into early and late stages.  During the early perimenopause women experience irregular menstrual bleeding while during the late perimenopause women begin skipping menstrual periods for 2-11 months.  Of the two stages the late perimenopause in particular had the greatest likelihood for high frequency headache increasing its risk by 86%.  This could suggest that low estrogen and progesterone levels, which occur when menstrual periods are skipped, might account for the increased probability of headache attacks in women with migraine. The common belief in the medical field is that migraine attacks improve in women during menopause.  To the contrary we found that high frequency migraine increased by 76% during menopause compared to premenopause.  This indicates that a subgroup of women with frequent headaches tend to worsen with menopause.  The increased probability of high frequency headache appeared to be secondary to an increased intake of pain medications occurring during this time period, which could result in “rebound headaches”.  Rebound headaches occur from overuse of pain medications.
Annals Internal Medicine, Author Interviews, Menopause, Pain Research / 23.01.2016

[caption id="attachment_20875" align="alignleft" width="133"]Acupuncture-Wikipedia-Image Acupuncture Presure[/caption] MedicalResearch.com Interview with: Carolyn Ee, MBBS Department of General Practice University of Melbourne Carlton, Victoria, Australia Medical Research: What is the background for this study? What are the main findings? Response: Hot flushes affect up to 90% of women during the menopause and beyond, and women are turning to complementary therapies. Our randomised sham-controlled trial found no difference between real and sham acupuncture (given with a blunt needle) for hot flushes, with both groups improving by around 40% at the end of treatment.
Author Interviews, BMJ, NYU/NYMC, Pain Research / 15.01.2016

[caption id="attachment_15303" align="alignleft" width="159"]Dr. Mia T. Minen, MD, MPH Director, Headache Services at NYU Langone Medical Center Assistant professor, Department of Neurology Dr. Mia T. Minen[/caption] More on Mental Health Research on MedicalResearch.com MedicalResearch.com Interview with: Dr Mia Tova Minen Department of Neurology NYU Langone Medical Center New York, NY 10016 Medical Research: What is the background for this study? What are the main findings? Dr. Minen: Migraine affects 12% of adults in the United States, and is thus a very common condition. There are effective treatments for migraine patients, but we also know that if patients and their doctors do not consider the psychiatric disorders that can co-occur with migraine, migraines can worsen, a term called migraine chronification. Thus, we felt that it was important to discuss the various psychiatric disorders associated with migraine, the screening tools available to assess for them, and various treatment considerations for patients with migraine and psychiatric conditions. We also discussed potential explanations for the relationship between migraine and these psychiatric conditions.
Author Interviews, Gastrointestinal Disease, Pain Research / 15.01.2016

[caption id="attachment_20649" align="alignleft" width="150"]Prof. Guy Boeckxstaens Translational Research in GastroIntestinal Disorders KU Leuven, Belgium Prof. Guy Boeckxstaens[/caption] More on Gastroenterology on MedicalResearch.com MedicalResearch.com Interview with: Prof. Guy Boeckxstaens Translational Research in GastroIntestinal Disorders KU Leuven, Belgium Medical Research: What is the background for this study? What are the main findings? Prof. Boeckxstaens: Patients with IBS have increased abdominal pain for which no efficient therapy is available, mainly as the underlying cause is unclear. In our study, we checked the hypothesis that pain receptors (in particular TRPV1) in the gut wall of IBS patients are more sensitive (sensitized) than those of control subjects. Based on previous work, we focused on histamine, mainly as we had indications that mast cells releasing histamine may be involved in IBS. Interestingly, we noticed that neurons in rectal biopsies were indeed more sensitive to capsaicin, a substance of which we know it selectively acts on the pain receptors of interest. We could demonstrate that histamine sensitizes TRPV1 via interaction with its histamine 1 receptor (H1R). We next showed that treatment with a H1R blocker was able to prevent TRPV1 sensitization. Based on this observation, we decided to start a pilot study evaluating the effect of a H1R blocker, ebastine, in patients suffering from IBS. This study showed that 12 weeks treatment with ebastine indeed improved abdominal symptoms, in particular pain.
Author Interviews, Exercise - Fitness, JAMA, Orthopedics, Pain Research / 11.01.2016

Daniel Steffens, Ph.D. The George Institute for Global Health The University of SydneyMedicalResearch.com Interview with: Daniel Steffens, Ph.D. The George Institute for Global Health The University of Sydney Medical Research: What is the background for this study? Dr. Steffens: Back pain is a leading cause of disease burden globally. At present, a variety of interventions, such as getting a mattress that can help with back pain, exercise, education, back belts and shoe insoles, are commonly prescribed to prevent an episode of low back pain. Guidelines lack clear recommendations for prevention of low back pain and the effectiveness of the range of possible prevention strategies for low back pain is not clear. Our study aimed to investigate the effectiveness of these interventions for prevention of low back pain.
Annals Internal Medicine, Author Interviews, Emergency Care, Opiods, Pain Research / 29.12.2015

[caption id="attachment_20345" align="alignleft" width="177"]Dr. Marc LaRochelle MD MPH Dr. LaRochelle[/caption] MedicalResearch.com Interview with: Marc R. Larochelle, MD, MPH Assistant Professor of Medicine Boston Medical Center Boston, MA  Medical Research: What is the background for this study? What are the main findings? Dr. Larochelle: More than 16 thousand people in the United States die from prescription opioid overdose each year. However, morbidity extends well beyond fatal overdose - nearly half a million emergency department visits each year are related to prescription opioid-related harms. Emergency department visits for misuse of opioids represent an opportunity to identify and intervene on opioid use disorders, particularly for patients who receive prescriptions for opioids to treat pain. We examined a cohort of nearly 3000 commercially insured individuals prescribed opioids for chronic pain who were treated for a nonfatal opioid overdose in an emergency department or inpatient setting. We were interested in examining rates of continued prescribing after the overdose and the association of that prescribing with risk of repeated overdose. We found that 91% of individuals received another prescription for opioids after the overdose. Those continuing to receive opioids at high dosages were twice as likely as those whose opioids were discontinued to experience repeated overdose.
Anesthesiology, Author Interviews, Emergency Care, Pain Research / 09.12.2015

[caption id="attachment_19946" align="alignleft" width="72"]Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX Dr. April[/caption] MedicalResearch.com Interview with: Michael D. April, MD, DPhil Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium San Antonio, TX  Medical Research: What is the background for this study? What are the main findings? Dr. April: Anesthesia research studies have found that nasal inhalation of isopropyl alcohol has efficacy in treating nausea among post-operative patients. We sought to study this agent among Emergency Department patients with nausea or vomiting. We found that patients randomized to inhale isopropyl alcohol had improved self-reported nausea scores compared to patients randomized to inhale saline (placebo). MedicalEditor's note:  Do Not Do This Without Medical Supervision!
Anesthesiology, Author Interviews, Pain Research / 03.11.2015

[caption id="attachment_19038" align="alignleft" width="225"]Dr Emmanuel Boselli, MD, PhD Anesthesiology and Intensive Care University Claude Bernard Lyon I University of Lyon Lyon, France Dr. Boselli[/caption] MedicalResearch.com Interview with: Dr Emmanuel Boselli, MD, PhD Anesthesiology and Intensive Care University Claude Bernard Lyon I University of Lyon Lyon, France Medical Research: What is the background for this study? What are the main findings? Dr. Boselli: We hypothesized that the use of conversational hypnosis in patients undergoing regional anesthesia procedures for ambulatory upper limb surgery might provide better comfort than the use of oral premedication during the regional anesthesia procedure. We assessed the subjective effect of conversational hypnosis on a patient self-reported comfort scale ranging from 0 (no comfort) to 10 (maximal comfort), and the objective effect was assessed using the Analgesia/Nociception Index (ANI), a 0-100 index derived from heart rate variability reflecting the relative parasympathetic tone. In our study of 100 patients undergoing hand surgery in two different centers, 50 had conversational hypnosis while being given regional anesthesia (Saint-Grégoire hospital), and 50 were given of oral hydroxyzine 30 minutes to an hour before the regional anesthesia procedure (Lyon hospital). Patients having hypnosis measured an average ANI of 51 before and 78 after hypnosis, whereas those who had premedication averaged 63 before and 70 after. The average comfort scale of those who had received hypnosis was 6.7 before and 9.3 after, while patients who had medication averaged 7.8 before and 8.3 after. The main finding of this study is that conversational hypnosis induced greater increase in comfort scales and ANI values than oral premedication. Medical Research: What is conversational hypnosis? What does it consist of? Dr. Boselli: Conversational hypnosis consists of matching the patient's behavioral communication patterns, reflective listening, avoiding any negative suggestion (e.g. "Keep calm and quiet" instead of "Please don't move!") and focalizing the patient's attention on something else than the regional anesthesia procedure, such as the ultrasound machine screen.
Author Interviews, Opiods, Pain Research / 28.10.2015

[caption id="attachment_18854" align="alignleft" width="133"]Richard L. Rauck, M.D. Director of Carolinas Pain Institute Winston Salem, NC Dr. Richard Rauck[/caption] MedicalResearch.com Interview with: Richard L. Rauck, M.D. Director of Carolinas Pain Institute Winston Salem, NC Medical Research: How large is the problem of chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment and for whom alternative treatment options are inadequate? Dr. Rauck: Chronic pain affects more than 100 million Americans - more than diabetes, heart disease and cancer combined. It is the most common cause of long-term disability, costing the U.S. billions of dollars annually in medical costs and lost wages and productivity.   Medical Research: What are the main medical conditions associated with this type of pain?  Dr. Rauck: A National Institute of Health Statistics survey indicated that low back pain is the most common cause of chronic pain (27%), followed by severe headache or migraine pain (15%), neck pain (15%) and facial ache or pain (4%).
Author Interviews, Emergency Care, Pain Research / 19.10.2015

Benjamin W. Friedman MD, MS Department of Emergency Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx, New YorkMedicalResearch.com Interview with: Benjamin W. Friedman MD, MS Department of Emergency Medicine Montefiore Medical Center Albert Einstein College of Medicine Bronx, New York Medical Research: What is the background for this study? What are the main findings? Dr. Friedman: Low back pain is responsible for 2.4% of visits to emergency departments resulting in 2.7 million visits annually. Pain outcomes for these patients are generally poor. One week after an ED visit in an unselected low back pain population, 70% of patients report persistent back-pain related functional impairment and 69% report analgesic use. Three months later, 48% report functional impairment and 46% report persistent analgesic use. Treatment of  Low back pain with multiple concurrent medications is common in the ED setting. Data from a national sample show that emergency physicians often prescribe NSAIDs, skeletal muscle relaxants, and opioids in combination—26% of patients receive a NSAID combined with a skeletal muscle relaxant and 26% also receive an NSAID combined with an opioid. Sixteen percent of patients receive all three classes of medication. Several clinical trials have compared combination therapy with NSAIDS + skeletal muscle relaxants to monotherapy with just one of these agents. These trials have reported heterogeneous results. The combination of opioids + NSAIDS has not been well evaluated in patients with acute low back pain. Given the poor pain and functional outcomes that persist beyond an ED visit for musculoskeletal LBP and the heterogeneity in clinical care, we conducted a randomized comparative efficacy study with the following objective. To compare pain and functional outcomes one week and three months after ED discharge among patients randomized to a ten day course of: 1) naproxen + placebo 2) naproxen + cyclobenzaprine or 3) naproxen + oxycodone/acetaminophen.
Author Interviews, JAMA, Pain Research / 13.10.2015

MedicalResearch.com Interview with: Julie M. Fritz, PT, PhD, FAPTA Professor, Department of Physical Therapy Associate Dean for Research, College of Health University of Utah Salt Lake City, UT  84106 Medical Research: What is the background for this study? What are the main findings? Dr. Fritz: Low back pain affects up to 80% of adults at some point in their lives and back pain is among the most common reasons why someone visits their primary care provider.  Despite how common back pain is, the health care system does a surprisingly poor job of managing patients with the condition. There are many things that can happen at the initial primary care visit for back pain that are unhelpful or may even delay recovery such as ordering an MRI or prescribing opioids. Most practice guidelines recommend that primary care providers avoid ordering an MRI or opioid pain medication, reassure the patient that they will begin to feel better quickly and then wait a few weeks before considering referral to physical therapy.  Others have suggested that earlier use of physical therapy may be more beneficial to patients.  We conducted this study to compare early physical therapy with a wait-and-see approach.
Author Interviews, Dermatology, Pain Research / 18.09.2015

psoriasis foundationMedicalResearch.com Interview with: Alexander Egeberg, MD Department of Cardiology Herlev and Gentofte Hospital Hellerup, Denmark Medical Research: What is the background for this study? What are the main findings? Dr. Egeberg: Psoriasis is a common chronic skin disease, with a strong inflammatory component. Within the last decade, our understanding of psoriasis have advanced significantly, and psoriasis is now widely regarded as a systemic disease, where the skin is a direct marker of disease activity. The inflammatory pathways in psoriasis have also been implicated in several central nervous system diseases such as depression, uveitis, and multiple sclerosis. Moreover, pain generation and sensitization can occur as a result of the pro-inflammatory mediators which are upregulated in psoriasis. In the present study, we investigated the association between psoriasis and psoriatic arthritis, and the risk of new-onset migraine. The main finding was a psoriasis-severity dependent increased risk of new-onset migraine, and patients with severe skin psoriasis, and psoriatic arthritis appeared to have the highest risk.
Author Interviews, Cancer Research, Pain Research, Pediatrics / 16.09.2015

Prof. Dr. Holger Lode Clinical Immunology, Pediatrics University of Greifswald, GreifswaldMedicalResearch.com Interview with: Prof. Dr. Holger Lode Clinical Immunology, Pediatrics University of Greifswald, Greifswald Medical Research: What is the background for this study? Response: Neuroblastoma is a cancer in childhood with one of the highest death rates.  Standard treatment is already very intensive. It includes chemotherapy, surgery, radiation, high dose chemotherapy followed by autologous stem cell transplantation. However, the progress made in improving survival rates is still poor. The use of an immune-modulatory treatment with a neuroblastoma specific monoclonal antibody ch14.18 (100 mg/m2 /cycle) in combination with cytokines and 13cis retinoic acid (13 cis RA) has shown benefit for patients with this disease [1].  This antibody targets ganglioside GD2 abundantly expressed on neuroblastoma with limited to no expression on healthy tissue. Low expression of GD2 on pain fibers is associated with an on-target side effect of the treatment, which is the induction of neuropathic pain. Approval of ch14.18 (dinutuximab) for the treatment of children with neuroblastoma has been provided by FDA. In Europe, ch14.18 was not available for a long time. There were several reasons why the antibody in the US could not be given to children in Europe. Therefore a new development of this side of the Atlantic was initiated following the remanufacturing of the antibody in CHO cells [2] (dinutuximab beta) and was made available within clinical trials of the SIOPEN group. The SIOPEN group is a network of leading European pediatric oncology centers to improve outcome for children with neuroblastoma (http://www.siopen.org), similar to the COG (children`s oncology group in the USA; https://www.childrensoncologygroup.org). Following the recloning procedure, ch14.18/CHO was first evaluated for safety in a Phase I study [3], which confirmed the tolerability and showed activity at a dosing regimen of 20 mg/m2 given by 8 hour infusions on 5 consecutive days. Dinutuximab beta is further developed by Apeiron Biologics. The current way to apply 100 mg /m2 / cycle is by 4 short term infusions of 25 mg/m2/day each over 8 hrs on 4 consecutive days. The entire treatment consists of 5 cycles. The drawback is that STI is associated with a high amount of intravenous morphine required to make this treatment tolerable for patients. Also the rate of inflammatory side effects observed is substantial. Clinical observation indicates that if patients treated by STI suffer from pain despite analgesic treatments, a decrease in speed of antibody infusion improves this on target toxicity. Therefore, we hypothesized that significant prolongation of the time of antibody infusion will improve tolerability of that treatment, but at the same time maintains clinical activity and efficacy in high risk neuroblastoma patients.
Author Interviews, JAMA, Pain Research, Pediatrics, Race/Ethnic Diversity, Surgical Research / 14.09.2015

Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC MedicalResearch.com Interview with: Monika Goyal, MD Pediatric emergency medicine Children’s National Hospital Washington, DC Medical Research: What is the background for this study? What are the main findings? Dr. Goyal: Appendicitis is a painful surgical condition and adequate analgesia, particularly with opioids, are considered one of the mainstays of management. We found that almost half of all children diagnosed with appendicitis did not receive any analgesia. Furthermore, among the patients that did receive analgesia, there were marked racial differences with black children having lower rates of opioid medication receipt than white children, even after we took pain scores or acuity level into account.
Author Interviews, Opiods, Pain Research / 10.09.2015

Lynn Webster, M.D. Vice President of Scientific Affairs PRA Health Sciences (lead study investigator, and former President of the American Academy of Pain Medicine) photo: WikipediaMedicalResearch.com Interview with: Lynn Webster, M.D. Vice President of Scientific Affairs PRA Health Sciences (lead study investigator, and former President of the American Academy of Pain Medicine) Medical Research: What is the background for this study? What are the main advantages of the buccal film? Dr. Webster: Because of its partial agonist activity and high affinity for mu-opioid receptors, buprenorphine has the potential to precipitate withdrawal in patients who are already on mu-opioid full agonists.  As a result, the current practice is to taper patients who are on around-the-clock (ATC) opioid therapy to a morphine sulfate equivalent (MSE) dose before switching to buprenorphine.  But tapering can result in a loss of pain control for patients.  For this study, we wanted to determine if patients on around-the-clock opioid full agonist therapy could be safely transitioned to buprenorphine HCl buccal film – an opioid partial agonist administered through the buccal mucosa – without the need for an opioid taper, and without inducing opioid withdrawal or sacrificing pain control.  Buprenorphine HCl buccal film is the first pain product in development to combine the efficacy of buprenorphine with this unique delivery system, which allows for efficient and convenient delivery of buprenorphine into the bloodstream.
Author Interviews, Cancer Research, Pain Research / 27.08.2015

Dr. Sebastiano Mercadante MD Director, Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center, Palermo, ItalyMedicalResearch.com Interview with: Dr. Sebastiano Mercadante MD Director, Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center, Palermo, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Mercadante:  Breakthrough cancer pain (BTcP) has been defined as a transitory increase in pain intensity that occurs either spontaneously, or in relation to a specific predictable or unpredictable trigger, despite relatively stable and adequately controlled background (1). Breakthrough cancer pain is a common problem in patients with cancer and is associated with significant morbidity. In a recent report in which a pragmatic definition of breakthrough cancer pain was used (2), the prevalence of BTcP was 75% (3). Oral morphine (OM) has been traditionally offered as a breakthrough cancer pain medication in doses of about 1/6 of the daily opioid regimen for years, although this approach has never been supported by any evidence. Different technologies have been developed to provide a rapid onset of effect with potent opioid drugs such as fentanyl (rapid onset opioids, ROOs) delivered by non-invasive routes. Fentanyl products have been shown to be significantly superior to oral opioids, but it has been suggested that the dose of fentanyl should be individually titrated in order to enable effective analgesia to be delivered while minimizing the risk of clinically significant adverse effects. The need of dose titration with rapid onset opioids has never been appropriately assessed and this statement is derived by a series of weaknesses of papers published for regulatory issues. Indeed, the only existing study comparing dose titration and proportional doses, reported that proportional doses of (Fentanyl buccal tablet) FBT are more effective and safe over dose titration method. NICE guidelines did not provide evidence for that, at least at certain time intervals after administration. To scientifically compare rapid onset opioids and oral morphine, we used a similar approach and made a strict selection of patients, according to a more specific algorithm for a diagnosis o fbreakthrough cancer pain. Thus, patients were randomized to receive in a crossover design Fentanyl buccal tablet and oral morphine, both given in doses proportional to opioid daily doses, for the management of breakthrough cancer pain. This comparative study has shown that, when giving the drugs for breakthrough cancer pain in doses proportional to the opioid regimen for background pain, Fentanyl was clearly superior for efficacy and rapidity in comparison with oral morphine. The analgesic effect was more intense either at 15 and 30 minutes after study medications were given. A larger number of episodes treated with Fentanyl buccal tablet  presented a decrease in pain intensity of ≥33% and ≥50% in comparison with episodes treated with oral morphine, and a relevant difference in SPID30 was reported. Of interest, adverse effects commonly observed in patients receiving opioids were not severe and did not differ between the treatments, suggesting that the use of proportional doses of both drugs are safe, reflecting what is derived by the long-lasting experience with oral morphine.  
Author Interviews, Lancet, Pain Research, Surgical Research / 14.08.2015

Dr Martin Hirsch Clinical Research Fellow Women’s Health Research Unit Queen Mary University of LondoMedicalResearch.com Interview with: Dr Martin Hirsch Clinical Research Fellow Women’s Health Research Unit Queen Mary University of London and Dr Jenny Hole Foundation Year 1 Doctor Kettering University Hospital Dr Jenny Hole Foundation Year 1 Doctor Kettering University Hospital   MedicalResearch: What is the background for this study? What are the main findings? Response: As doctors we see medicines being prescribed on a daily basis and the benefit but also harm that they can cause. We wanted to assess the role of non pharmaceutical interventions which can benefit patients with a low or minimal potential for harm. We all have an interest in music of different genres and we agreed that we didn’t know anybody who did not like music of one sort or another. On the basis that we all have gained pleasure from music, we wanted to see if this pleasurable experience at the time of a difficult and painful stimulus could reduce the problems encountered as people recover from surgery. We searched all published medical literature and found 73 of the highest quality studies (randomised controlled trials) to compare and combine their findings in a meta-analysis. This technique aims to strengthen the validity by producing a combined result. We found that using music before during or after surgery reduced pain, reduced the requirement for pain killers, reduced anxiety, and improved satisfaction.
Author Interviews, NIH, Pain Research / 14.08.2015

Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, MarylandMedicalResearch.com Interview with: Richard L. Nahin, Ph.D., M.P.H National Center for Complementary and Integrative Health National Institutes of Health, Bethesda, Maryland Medical Research: What is the background for this study? Dr. Nahin: In 2011 the Institute of Medicine published a blueprint for transforming pain care in the United States.  In this report the IOM noted the lack of a comprehensive picture of pain’s prevalence and severity in the U.S., and especially noted that lack of data examining racial and ethnic groups. The current analysis of data from the 2012 National Health Interview survey is a step toward addressing these deficiencies.  Medical Research: What are the main findings? Dr. Nahin: The analyses found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain.  Those with severe pain are also likely to have worse health status.  There were associations between pain severity and race, ethnicity, language preference, gender, and age. Women, older individuals, and non-Hispanics were more likely to report any pain, while Asians were less likely.  Minorities who did not choose to be interviewed in English are markedly less likely to report pain.
Author Interviews, Dermatology, JAMA, NIH, Pain Research / 07.08.2015

Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, MarylandMedicalResearch.com Interview with: Edward W. Cowen, MD, MHSc Dermatology Branch, Center for Cancer Research National Cancer Institute Bethesda, Maryland Medical Research: What is the background for this study? Dr. Cowen: Cutaneous leiomyomas are benign smooth muscle proliferations that are associated with pain that is typically not well-controlled by topical remedies or systemic pain medication. Hereditary leiomyomatosis and renal cell cancer is a rare syndrome in which patients may have dozens or even hundreds of these painful tumors. We sought to determine if botulinum toxin injected directly into leiomyomas may ameliorate discomfort and improve quality of life in patients who experience significant pain from cutaneous leiomyomas. Medical Research: What are the main findings? Dr. Cowen: In a double-blinded placebo-controlled study, we found that injection of botulinum toxin was associated with improved skin-related quality of life (p = 0.007) and decreased skin-specific pain (p = 0.048) on the Dermatology Life Quality Index. A trend for decreased pain (p = 0.06) by visual analog score was reported in the botulinum toxin treated group compared to the placebo group.
Author Interviews, Pain Research / 07.08.2015

MedicalResearch.com Interview with: Jane Marjoribanks Obstetrics and Gynaecology University of Auckland, National Women's Hospital, Auckland, New Zealand MedicalResearch: What is the background for this study? Response: This study is a systematic review of all randomised evidence published up to January 2015 on the effectiveness and safety of non-steroidal inflamatory drugs (NSAIDs) used to treat primary dysmenorrhoea (period pain). It includes 80 randomised controlled trials (total 5820 participants), which compare 20 different NSAIDs versus placebo, other NSAIDs or paracetamol. The review was prepared by researchers from the Cochrane Collaboration, which is a global independent network of contributors (37,000 from more than 130 countries) who gather and summarize the best evidence from research to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest.
Annals Internal Medicine, Author Interviews, Pain Research, Rheumatology / 30.07.2015

MedicalResearch.com Interview with: Raveendhara R Bannuru MD, PhD, FAGE Director, Center for Treatment Comparison and Integrative Analysis (CTCIA) Asst Professor of Medicine, Tufts University School of Medicine Special & Scientific Staff, Center for Arthritis and Rheumatic Diseases Tufts Medical Center Boston, MA Medical Research: What is the background for this study? Dr. Bannuru: Placebos are used to determine the efficacy of a wide variety of treatments for medical conditions such as osteoarthritis. A sound understanding of potential differences among placebos is essential for determining the relative efficacy of such treatments. Medical Research: What are the main findings? Dr. Bannuru: Our results indicate that different types of placebos do in fact differ in efficacy. Placebo injections and topical placebos were both found to be more effective than orally administered placebos for reducing knee osteoarthritis pain.
Author Interviews, Cannabis, Pain Research / 23.07.2015

Mark S. Wallace MD Department of Anesthesiology School of Medicine University of California, San Diego, CaliforniaMedicalResearch.com Interview with: Mark S. Wallace MD Department of Anesthesiology School of Medicine University of California, San Diego, California Medical Research: What is the background for this study? What are the main findings? Dr. Wallace: The study was funded by the center for medicinal cannabis research at the University of California San Diego. The center was funded by the state of California. The center was the first to fund a series of double-blind randomized controlled trials with inhaled cannabis for neuropathic pain. My trial is the first in diabetic peripheral neuropathy pain which is one of the most prevalent pain syndromes in our society with limited treatments. We found a dose dependent reduction in pain. However there was also a dose dependent increase in euphoria and sedation which may limit clinical use. Effects on neurocognitive functioning were minimal.
Author Interviews, BMJ, Emergency Care, Pain Research / 25.06.2015

MedicalResearch.com Interview with: Prof. Jason Smith Consultant in Emergency Medicine, Derriford Hospital, Plymouth, UK Royal College of Emergency Medicine Professor Defence Professor of Emergency Medicine, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, UK Honorary Professor in Emergency Medicine, Plymouth University Peninsula Schools of Medicine and Dentistry, UK Medical Research: What is the background for this study? Prof. Smith: Patients commonly present to emergency departments in pain. When patients are asked about their emergency department experience, they often say that more could have been done to manage their pain. Routine care for patients in moderate or severe pain who present to emergency departments usually involves intravenous (IV) morphine, delivered by a nurse. There may be a delay when patients are admitted to a hospital ward before they are reviewed by the admitting medical team, when their pain needs are reassessed. Patient controlled analgesia (PCA) is used to good effect elsewhere in the hospital. The aim of this study was to compare PCA with routine care in patients presenting to emergency departments with either traumatic injuries or non-traumatic abdominal pain, who require admission to hospital. Medical Research: What are the main findings? Prof. Smith: We found that significant reductions in pain were possible using patient controlled analgesia in patients with abdominal pain. Patients spent significantly less time in moderate or severe pain, and were more likely to be very or perfectly satisfied with their pain management. In patients with traumatic injuries, a modest (but non-significant) reduction in pain was seen in patients allocated to the PCA group compared with the routine care group. Patients in the PCA group were more likely to be very or perfectly satisfied with their pain management.
Author Interviews, Neurological Disorders, NYU/NYMC, Opiods, Pain Research, Pharmacology / 25.06.2015

Dr. Mia T. Minen, MD, MPH Director, Headache Services at NYU Langone Medical Center Assistant professor, Department of Neurology MedicalResearch.com Interview with: Dr. Mia T. Minen, MD, MPH Director, Headache Services NYU Langone Medical Center Assistant professor, Department of Neurology   Medical Research: What is the background for this study? What are the main findings? Dr. Minen: We conducted a survey on opioid and barbiturate use among patients visiting a headache center to find out which medications they were receiving for treatment. There’s limited evidence that long-term use of these medications can help treat headaches or migraines, and even short-term use in small quantities can cause medication overuse headache. It is important to determine which providers start these medications so that educational interventions can be tailored to these physician specialties to try to prevent situations such as incorrect prescribing practices and medication overuse. In this sample of patients from a specialty headache center, approximately 20 percent of patients -- or 1 in 5 -- were using opioids or barbiturates, and about half had been prescribed these medications at some point in the past for their headaches. These findings show that opioids and barbiturates are commonly prescribed to patients with headaches. While two-thirds of patients found opioids or barbiturates helpful, many did not like them, were limited by side effects or did not find them to be helpful. Emergency department physicians were reported to be the most frequent first prescribers of opioids and general neurologists were the most frequent prescribers of barbiturate-containing medications. Primary care physicians were also identified as frequent first prescribers of these medications.
Author Interviews, JAMA, Kaiser Permanente, Pain Research / 03.06.2015

Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser PermanenteMedicalResearch.com Interview with: Harley Goldberg, DO Physical Medicine and Rehabilitation Kaiser Permanente Medical Research: What is the background for this study? What are the main findings? Dr. Goldberg: This is the first large-scale randomized, double-blind, placebo-controlled clinical trial of oral steroids for acute radiculopathy, commonly called sciatica, associated with a herniated lumbar disk. Lumbar radiculopathy (or pain down the leg in a lumbar nerve root distribution) is a common source of pain and disability for many adults. It is thought that inflammation from a disk herniation is responsible for many of the symptoms, so giving a powerful anti-inflammatory, such as steroid medication, might help relieve sciatica symptoms quickly. Prior research has shown that lumbar diskectomy does not affect the one year outcome for most patients, and epidural steroid injections do not have strong support by clinical trials. If the use of epidural steroids injections is based on application of steroid anti-inflammatory to the affected nerve root(s), perhaps an oral steroid can have affect. Although oral steroids are used by many physicians and have been included in some clinical guidelines, no large-scale clinical trials of oral steroids for sciatica have been conducted before. Our study found that among patients with acute radiculopathy associated with a herniated lumbar disk, a short course of oral steroids resulted in only modest improvement in function and no significant improvement in pain.