Thunderclap Headache: Ottawa Rule To Exclude Subarachnoid Bleeding

MedicalResearch.com Interview with:

Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario

Dr. Perry

Jeff Perry, MD, MSc, CCFP-EM
Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa
Emergency Physician and Epidemiology Program
The Ottawa Hospital
Ottawa, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes.

The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance.

We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%.

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Methadone As First Line Opioid in Cancer Pain Management

MedicalResearch.com Interview with:

Sebastiano Mercadante, MD Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit La Maddalena Cancer Center Department of Anesthesia, Intensive Care & Emergencies University of Palermo Palermo, Italy

Dr. Mercadante

Sebastiano Mercadante, MD
Anesthesia and Intensive Care Unit and Pain Relief and Palliative Care Unit
La Maddalena Cancer Center
Department of Anesthesia, Intensive Care & Emergencies
University of Palermo
Palermo, Italy

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many clinical experiences suggesting that methadone, when optimally used by skilled physicians, has invaluable properties in the management of cancer pain. Methadone used as first opioid may provide interesting advantages due to the low tendency to induce tolerance, while providing a clinical profile similar to that of other opioids. Moreover, methadone possesses other extra-opioid effects that can be of interest.

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Migraines More Frequent With Increased Anxiety and Depression

MedicalResearch.com Interview with:

“Headache.” by Avenue G is licensed under CC BY 2.0

“Headache.” by Avenue G

Fu-Chi Yang, M.D., Ph.D.Assistant Professor
Department of Neurology,
Tri-Service General Hospital
National Defense Medical Center
Taipei, Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Migraineurs are likely to suffer from comorbid depression and anxiety. Furthermore, increased migraine frequency is associated with an increased risk of mood/anxiety disorders. It is not distinguished by grouping frequency of migraine attacks, whether it is associated with severity scores of depression and anxiety. Thus, we evaluated the relationship between severity of depression/anxiety and migraine frequency

We mainly found that the severity of depression (BDI and HADS-depression scores) and anxiety (HADS anxiety score) were related to migraine frequency, after adjusting confounding factors.

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Yoga May Reduce Disability and Opioid Use In Veterans With Chronic Low Back Pain

MedicalResearch.com Interview with:

Erik Groessl PhD Associate Adjunct Professor Family Medicine and Public Health University of California, San Diego

Dr. Groessl

Erik Groessl PhD
Associate Adjunct Professor
Family Medicine and Public Health
University of California, San Diego

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Chronic low back pain (cLBP) is prevalent among military veterans, but cLBP treatment options have limited benefits and side effects. This has resulted in efforts to reduce opioid use and embrace nonpharmacological pain treatments.

Yoga has been shown to improve health outcomes and have few side effects in non-veteran community samples.

Our objective was to study the effectiveness and safety of yoga for military veterans with chronic low back pain.  In a study of 150 veterans with cLBP, we found that yoga participants had greater reductions in disability and pain than those receiving usual. Opioid medication use declined among all participants, and no serious side effects occurred.

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Emotional Awareness and Expression Therapy Reduced Pain of Fibromyalgia

MedicalResearch.com Interview with:
Mark A. Lumley, Ph.D.
Distinguished Professor and Director of Clinical Psychology Training
Department of Psychology
Wayne State University
Detroit, Michigan  48202 and
Howard Schubiner, M.D
Founder and Director Mind-Body Medicine Center
Providence-Providence Park Hospitak
Warren, MI 48092 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Fibromyalgia is a condition that afflicts many people with chronic pain and other symptoms, which are often severe. There is no clear evidence of tissue damage or other peripheral causes of the symptoms, and experts agree that the pain is real, and its primary source is the brain. Medications for fibromyalgia have limited effectiveness, so psychological and behavioral therapies are core to treatment.

Research documents a strong relationship between emotions and pain, and many patients with FM struggle with negative emotions related to difficult life circumstances, such as trauma, abuse, or relationship conflicts. Ironically, most psychological therapies for FM do not address these problems, but rather teach people how to manage their symptoms. Emerging research, however, demonstrates that therapies that help patients engage rather than avoid their difficult emotional experiences improve both psychological and physical symptoms, including pain. Therefore, we developed an emotion-focused therapy, which we call Emotional Awareness and Expression Therapy (EAET), and compared it to both an active education-based control condition and to the leading psychological intervention for fibromyalgia, cognitive-behavior therapy (CBT).

The EAET condition was substantially better on multiple outcomes that the control condition 6 months after treatment. Importantly, although EAET did not differ from CBT on many outcomes, EAET was superior than CBT on reducing widespread and in the percentage of individuals achieving substantial pain reduction (that is, at least 50% pain reduction from baseline).

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Acupuncture and Electrotherapy Following Knee Replacement May Limit Opioid Use

MedicalResearch.com Interview with:

Tina Hernandez-Boussard, PhD MPH, MS Associate Professor of Medicine, Biomedical Data Science, and Surgery Stanford School of Medicine Stanford, CA 94305-5479

Dr. Hernandez-Boussard

Tina Hernandez-Boussard, PhD MPH, MS
Associate Professor of Medicine, Biomedical Data Science, and Surgery
Stanford School of Medicine
Stanford, CA 94305-5479

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Opioid addiction is a national crisis.  As surgery is thought to be a gateway to opioid misuse, opioid-sparing approaches for pain management following surgery are a top priority.

We conducted a meta-analysis of 39 randomized clinical trials of common non-pharmalogical interventions used for postoperative pain management.

We found that acupuncture and electrotherapy following total knee replacement reduced or delayed patients’ opioid use.

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Evidence Does Not Support Gabapentinoids in Non-Specific Chronic Low Back Pain

MedicalResearch.com Interview with:

Harsha Shanthanna MBBS, MD, MSc Associate Professor, Anesthesiology Chronic Pain Physician St Joseph's Healthcare,McMaster University Hamilton, Canada Diplomate in National Board, Anesthesiology (India) Fellow in Interventional Pain Practice (WIP) European Diplomate in Regional Anesthesia and Pain (ESRA)

Dr. Shanthanna

Harsha Shanthanna MBBS, MD, MSc
Associate Professor, Anesthesiology
Chronic Pain Physician
St Joseph’s Healthcare,McMaster University
Hamilton, Canada
Diplomate in National Board, Anesthesiology (India)
Fellow in Interventional Pain Practice (WIP)
European Diplomate in Regional Anesthesia and Pain

MedicalResearch.com: What is the background for this study?

Response: Pregabalin (PG) and gabapentin (GB) are increasingly used for nonspecific Chronic Low Back Pain (CLBP) despite a lack of evidence. There have been concerns expressed over their increased prescribing for various non cancer pain indications in recent years. Their use requires slow titration to therapeutic doses and establishing maintenance on a long-term basis. With prolonged treatment, the potential gain over possible adverse effects and risks could become unclear.

We searched Cochrane, MEDLINE and EMBASE databases for randomized control trials reporting the use of gabapentinoids for chronic lower back pain treatment of 3 months or more in adult patients.

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Oral Glucosamine Found No More Effective Than Placebo For Osteoarthritis Pain

MedicalResearch.com Interview with:

Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands

Dr. Runhaar

Jos Runhaar, PhD
Erasmus MC
Department of General Practice
Rotterdam
The Netherlands 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages.

For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding.

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Long Acting Local Anesthetic Reduced Need For Opioids After Knee Replacement

MedicalResearch.com Interview with:

Michael A. Mont, MD Department of Orthopaedic Surgery Cleveland Clinic Cleveland, OH

Dr. Mont

Michael A. Mont, MD
Department of Orthopaedic Surgery
Cleveland Clinic
Cleveland, OH 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Postoperative pain after total knee arthroplasty (TKA) is a major hurdle for both the patients and the orthopaedists. Many analgesic modalities are currently in use, and can be used alone or in combination in order to augment their effect. Addition of local anesthetic analgesia has been shown to improve pain control and reduce opioid consumption during postoperative period. However, the effects of this analgesia tend to dissipate with time, with the longest duration of action (bupivacaine) of approximately 12 hours. Therefore, long acting local anesthetic (liposomal bupivacaine) has been developed in order to expand the duration of effectiveness of pain relief for up to 96 hours. Many studies evaluated the effectiveness of this anesthetic and demonstrated contradictory results, however, they did not use the same methods and infiltration technique. Therefore, we conducted a prospective, randomized, double-blind, controlled study at 16 hospitals using optimal infiltration techniques. Our study demonstrated significant improvement in pain, decreased opioid consumption, increased time to first opioid rescue, more opioid free patients in liposomal bupivacaine cohort. In addition, there were no unexpected safety concerns.

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Primary Care Practice Interventions Helped Maintain Adherence to Opioid Prescription Guidelines

MedicalResearch.com Interview with:

Jane M. Liebschutz, MD, MPH Associate Professor of Medicine Section of General Internal Medicine Boston University School of Medicine Boston, Massachusetts

Dr. Liebschutz

Jane M. Liebschutz, MD, MPH
Associate Professor of Medicine
Section of General Internal Medicine
Boston University School of Medicine
Boston, Massachusetts

MedicalResearch.com: What is the background for this study?

Response: The number of patients receiving opioids for chronic pain has risen over the past 2 decades in the US, in parallel with an increase in opioid use disorder. The CDC and professional medical societies have created clinical guidelines to improve the safety of opioid prescribing, yet individual prescribers can find them onerous to implement.

We developed an intervention to change clinical practice to support primary care physicians who prescribe the majority of opioids for chronic pain. The intervention included 4 elements- a nurse care manager to help assess, educate and monitor patients, an electronic registry to keep track of patient data and produce physician level reports, an individualized educational session for the physician by an opioid prescribing expert based on the physician-specific practice information and online resources to help with decision-making for opioid prescribing (www.mytopcare.org). We tested whether the intervention would improve adherence to guidelines, decrease opioid doses and decrease early refills, as a marker of potential prescription opioid misuse among 985 patients of 53 primary care clinicians in four primary care practices.

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Electroacupuncture Reduced Leakage in Stress Urinary Incontinence

MedicalResearch.com Interview with:
Baoyan Liu, MD
Guang’an Men Hospital
China Academy of Chinese Medical Sciences
Beijing, China

Patient with Electroacupuncture

Patient with Electroacupuncture

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The prevalence of stress urinary incontinence(SUI) is as high as 49% and varies according to the population studied and the definition of stress urinary incontinence.

SUI causes psychological burden, affects relationships, lowers physical productivity, and decreases quality of life in women. Yet, few effective therapies are available for treating stress urinary incontinence.

In this randomized clinical trial that included 504 women, the mean decrease in urine leakage, measured by the 1-hour pad test from baseline to week 6, was 9.9 g with
electroacupuncture vs 2.6 g with sham electroacupuncture, a significant difference.

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Yoga As Effective As Physical Therapy For Chronic Low Back Pain

MedicalResearch.com Interview with:

Robert B. Saper, MD, MPH Department of Family Medicine Boston Medical Center Boston, MA

Dr. Saper

Robert B. Saper, MD, MPH
Department of Family Medicine
Boston Medical Center
Boston, MA

MedicalResearch.com: What is the background for this study?

Response: There are a number of studies that show that yoga is effective for chronic low back pain (cLBP), but those studies included mostly white and middle-class individuals as research participants. cLBP disproportionately impacts those who are economically disadvantaged and minorities; they receive less referrals to specialists, less referrals to rehabilitation, and also less patient-education. Therefore, it was important to test whether yoga would be well- received by an underserved population, as well as be an effective form of treating chronic low back pain.

This study consisted of patients from diverse racial and economic backgrounds with multiple medical problems who were able to successfully participate and benefit from both yoga and physical therapy. This study used yoga classes that were specifically designed for people suffering from  chronic low back pain and compared the results of that treatment to those who did physical therapy.

MedicalResearch.com: What are the main findings?

Response: The results show that the yoga was as effective as physical therapy for reducing pain intensity and improving people’s physical function. Patients in the study who did yoga reported that their overall pain intensity went down, that they were able to be more physically active, and a number of patients were also able to reduce or even stop all of their pain medication. The study shows that when yoga is made available and affordable to a diverse population, people of both sexes, people who are disabled, and people of different races and economic backgrounds are both receptive to yoga and, more importantly, can benefit from it.

MedicalResearch.com: What should readers take away from your report?

Response: Doctors should know that a structured yoga program for cLBP is a reasonable, effective, and safe approach for patients with chronic  chronic low back pain. Patients with cLBP should talk with their doctors about different options for treatment of back pain, starting with non-drug approaches like yoga and physical therapy. Policy makers need to examine the potential benefits for patients and cost savings for covering non-pharmacological approaches to pain.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The cost effectiveness of yoga and physical therapy for chronic low back pain still needs to be looked at carefully, as well as how the medical community can implement yoga classes for back pain widely.

While medication, imaging and invasive procedures absolutely have their place, research and clinical guidelines show that non-pharmacological procedures as first treatment options may be best.

MedicalResearch.com: Is there anything else you would like to add?

Response: Yoga is increasingly popular in the United States, and many yoga teachers are available in urban areas. However, yoga teachers and yoga classes are still relatively rare in communities of color and disadvantaged areas. Therefore, it’s important that we begin to train, build, and make yoga more available to diverse communities. Changing the common view of yoga from a fitness exercise for the healthy and wealthy, to a therapeutic approach for people with chronic pain and other conditions, is also an ongoing challenge.

Finding that yoga is non-inferior to physical therapy makes a strong case that yoga programs like the one in this study should be covered by insurance and offered by health care facilities. When a therapy like yoga is shown to be as effective as standard therapies, it should be made available to everyone regardless of ability to pay. For patients who attended more classes or physical therapy sessions, their cLBP improvement was even greater.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Saper RB, Lemaster C, Delitto A, Sherman KJ, Herman PM, Sadikova E, et al. Yoga, Physical Therapy, or Education for Chronic Low Back Pain: A Randomized Noninferiority Trial. Ann Intern Med. [Epub ahead of print 20 June 2017] doi: 10.7326/M16-2579

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

SIMPONI ARIA (golimumab) Improved Sleep and Pain in Ankylosing Spondylitis Trial

MedicalResearch.com Interview with:

Atul A. Deodhar, MD, MRCP, FACP, FACR Professor of Medicine Medical Director, Rheumatology Clinics Medical Director, Immunology Infusion Center Oregon Health & Science University 

Dr. Deodhar

Atul A. Deodhar, MD, MRCP, FACP, FACR
Professor of Medicine
Medical Director, Rheumatology Clinics
Medical Director, Immunology Infusion Center
Oregon Health & Science University 

MedicalResearch.com: What is the background for this study?

Response: The GO-ALIVE study (CNTO148AKS3001) is a multicenter, randomized, double-blind, placebo-controlled study of golimumab, an anti-TNFα monoclonal antibody, administered intravenously (IV), in adult patients with active ankylosing spondylitis (AS). The primary objective is to evaluate the efficacy of golimumab 2 mg/kg in patients with active AS by assessing the reduction in signs and symptoms of AS. The secondary objectives include assessing efficacy related to improving physical function, range of motion, health-related quality of life, and other health outcomes.

A total of 208 patients who had a diagnosis of definite  ankylosing spondylitis (per modified New York criteria) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) ≥4, total back pain visual analogue scale (VAS) ≥4, and CRP ≥0.3 mg/dL were randomized.  Patients were treated with IV golimumab (n=105) at Weeks 0, 4, and every 8 weeks through Week 52 or placebo (n=103) at Weeks 0, 4, and 12, with crossover to IV golimumab at Week 16 and through Week 52.

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Statins Users May Have Higher Likelihood of Back Disorders

MedicalResearch.com Interview with:

Una Makris MD, MSc Clinical Investigator at the VA North Texas Health System Assistant Professor at UT Southwestern Medical Center Departments on Internal Medicine and Clinical Sciences

Dr. Makris

Una Makris MD, MSc
Clinical Investigator at the VA North Texas Health System
VA North Texas Health Care System
Assistant Professor at UT Southwestern Medical Center
Departments on Internal Medicine and Clinical Sciences
Dr. Makris is a Rheumatologist, clinically, and spends the majority of time focused on clinical research investigating how to improve outcomes for adults with back pain.

MedicalResearch.com: What is the background for this study?

Response: Back pain is the most common type of musculoskeletal (MSK) pain. We know that expenditures for back pain exceed $100 billion each year (and this was in 2005). Back pain results in tremendous disability (including reduced mobility) and impaired quality of life (not exclusive to physical consequences, but also including important psychosocial repercussions). We also know that statins are prescribed very often, and frequently in younger populations who are active. Some reports suggest that statins may have a protective effect on  musculoskeletal conditions such as back pain.

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Proove Opioid Risk Profile Predictive of Opioid Use Disorder

MedicalResearch.com Interview with:

Maneesh Sharma, M.D</strong> Director of Pain Medicine MedStar Good Samaritan Hospital Medical Director of the Interventional Pain Institute Baltimore, Maryland

Dr. Maneesh Sharma

Maneesh Sharma, M.D
Director of Pain Medicine
MedStar Good Samaritan Hospital
Medical Director of the Interventional Pain Institute
Baltimore, Maryland

MedicalResearch.com: What is the background for this study?

Response: Opioid abuse in chronic pain patients is a major public health issue, with rapidly increasing addiction rates and deaths from unintentional overdose more than quadrupling since 1999. Just in the last year alone according to the CDC, synthetic opioid deaths have increased 72%. As a practicing interventional pain specialist, I am confronted with the challenge of assessing patient risk for opioids as I evaluate multi-modal approaches to effective pain management. Existing tools are inadequate, as they either rely on a urine toxicology test to evaluate a patient’s current potential substance abuse as a predictor of future abuse, or on a patient’s honesty to fill out a questionnaire. We know that many patients who are not currently abusing illicit drugs or misusing prescription medications can develop prescription opioid tolerance, dependence, or abuse—especially with prolonged opioid therapy. Furthermore, we know that patients who are looking to abuse medications or divert those prescriptions will obviously lie on questionnaires.
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Modest Effect of Spinal Manipulation For Back Pain

MedicalResearch.com Interview with:

Paul Shekelle, MD PhD MPH Chief of General internal Medicine VA Greater Los Angeles Healthcare System

Dr. Shekelle

Paul Shekelle, MD PhD MPH
Chief of General internal Medicine
VA Greater Los Angeles Healthcare System

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Back pain is one of the commonest symptoms for adult patients to seek health care. For a number of years now, VA has had chiropractic care integrated into the ambulatory care available at many large VA medical centers. Most patients referred from VA primary care to chiropractic clinic have chronic back pain. VA was interested in an evidence synthesis of the use of spinal manipulative therapy in acute low back pain. Spinal manipulative therapy is a manual technique delivered by almost all chiropractors, but also delivered by some physical therapists, osteopathic physicians, and some medical doctors.

The main findings are that spinal manipulative therapy is associated with, on average, a modest beneficial effect on pain and function. However, there are large difference sin outcome across studies, and this suggests that some patients may respond much better, and other may respond not at all.

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The Opioid Epidemic and Orthopaedic Pain Management

MedicalResearch.com Interview with:

Dr. Hammoud

Dr. Sommer Hammoud

Dr. Sommer Hammoud MD
ABOS Board Certified Assistant Professor of Orthopedic Surgery
Thomas Jefferson University 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The background for this exhibit stemmed from the growing problem of prescription opioid abuse in the United States.  As we saw this issue developing, we aimed to investigate the history behind this epidemic, what information we have now to fight it, and what information we need in the future to improve care our patients.

Our main findings for each of those aims are the following:

1) It would appear that a large push at the end of the last century led to a lower threshold to prescribe opiates in the effort to control pain, leading to the current opioid epidemic
2) Mulitmodal methods of pain control and the expanding skill of regional anesthesia can be used to help decrease narcotic use and thus limit exposure to narcotics, and
3) Future research needs to focus on the psychologic aspect of patients’ ability to manage pain and we should strive to be able to categorize patients in order to create an individualized pain management protocol which will most effectively manage pain.

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Cannabidiol Reduces Fear and Anxiety in Various Preclinical Models

MedicalResearch.com Interview with:
Carl Stevenson, PhD

Assistant Professor of Neuroscience
BSc Animal Science Admissions Tutor
Local Group Rep, British Neuroscience Association
School of Biosciences
University of Nottingham
Loughborough, UK

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Anxiety-related and substance abuse disorders can be serious forms of mental illness that are not always treated effectively by psychological therapies or medications. One strategy to enhance their treatment is to boost the effects of psychological therapy by combining it with medication.

This study reviewed the literature on the effects of cannabidiol, a chemical found in the cannabis plant, in preclinical models of these disorders. Cannabidiol is safe to use in humans and doesn’t cause the ‘high’ associated with cannabis. This means that cannabidiol might be useful for treating certain symptoms without the unwanted side effects linked to medical cannabis.

Our review confirmed that cannabidiol reduces fear and anxiety in various preclinical models, when given on its own or in conjunction with behavioural interventions that model psychological treatment for anxiety-related disorders. Our review suggested that it can also reduce relapse in some preclinical models of addiction, although research looking at the effects of cannabidiol in substance abuse disorders is still in its infancy.

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Migraine Associated With Cervical Artery Dissection In Some Young Adults

MedicalResearch.com Interview with:
Alessandro Pezzini, MD, FESO

Professore Associato di Neurologia
Dipartimento di Scienze Cliniche e Sperimentali
Clinica Neurologica
Università degli Studi di Brescia
Italia

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Scarce reports have suggested that a relation might exist between migraine and cervical artery dissection (CEAD), the most frequent cause of ischemic stroke in young adults in Western countries. However, data available so far were obtained from few studies conducted on small cohorts of patients, which limits the generalizability of their findings.

In our study we analysed the data from the Italian Project on Stroke in Young Adults (IPSYS) project, one of the largest registries of young ischemic stroke patients, and observed that migraine, especially the subtype without aura was strongly and independently associated to CEAD. This seems particularly true for men and for people younger than 39 years.

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Cedars-Sinai Study Will Address How Doctors Communicate With Patients About Chronic Pain

MedicalResearch.com Interview with:
Michelle S. Keller, MPH, PhD Candidate

Health Policy and Management
Cedars-Sinai
Los Angeles CA 90048

MedicalResearch.com: What is the background for this new funding award?

Response: Research shows that treating and managing chronic pain is tough, and it can be hard for patients and their physicians to be on the same page. Chronic pain touches so many facets of people’s lives—relationships, mental health, sleep, work—that treating it in a 15-minute visit can lead to a lot of frustration and disappointment.

Our hope is that by arming patients and clinicians with evidence-based tools, we can help foster a better dialogue about what is ultimately important to patients, how to achieve fully functional lives while managing chronic pain. We’re testing two different types of communication tools: electronic health record alerts pointing physicians to guidelines when they write opioid prescriptions and patient portal-based tools that can help patients prepare for visits and become active, engaged partners in their care.

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Leaky Gate Model Connects Intense Itch With Pain

MedicalResearch.com Interview with:

Xinzhong Dong PhD The Solomon H. Snyder Department of Neuroscience and Center for Sensory Biology Howard Hughes Medical Institute Johns Hopkins University School of Medicine Baltimore, MD 21205

Dr. Xinzhong Dong

Xinzhong Dong PhD
The Solomon H. Snyder Department of Neuroscience and Center for Sensory Biology
Howard Hughes Medical Institute
Johns Hopkins University School of Medicine
Baltimore, MD 21205

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is a puzzle that troubles the field for many years that how pain and itch, two closely related sensations (once thought as one sensation), are differentiated by the nervous systems. Coding of pain and itch are heatedly debated for decades. The current specificity theory suggests that these two kinds of signals are carried by separate pathways, with some interactions, for example pain can inhibit itch and that explains why we all scratch to inhibit pain. It is true in the periphery (our previous study indicate a small population of neurons in the periphery only codes for itch sensation), but now our study suggests that there could be more crosstalk between these two sensations in the central than we expected.

People might not notice in real life, but in human psychophysical studies, well-isolated experimental environments, when human subjects are given itchy substances, they typically report intense itch sensations accompanied by minor noxious sensations, such as pricking, stinging and burning. Our new leaky gate model suggest in certain circumstances intense itch signals can trigger minor pain sensations, which can explain such phenomenon.

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Radiation Therapy Improves Pain and Quality of Life in Bone

MedicalResearch.com Interview with:
Rachel McDonald, MD(C)

Department of Radiation Oncology
Odette Cancer Centre
Sunnybrook Health Sciences Centre
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Radiation treatment has been demonstrated in numerous studies to provide effective and timely pain relief to those suffering from painful bone metastases. However, as a palliative treatment, the goal should be not only to reduce pain but also to maintain and even improve quality of life. To date, studies have not effectively demonstrated this; most of these have included either small sample sizes or utilize questionnaires that aren’t tailored to the palliative cancer population with bone metastases.

We aimed to determine how soon after radiation treatment one can expect an improvement in quality of life. Our results showed that patients who had a pain response to radiation also had significantly greater improvements in pain, pain characteristics, functional interference, and psychosocial aspects of well-being at day 10 post-treatment. Further improvements in most domains of quality of life were found for responders at day 42.

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Is the Benefit of Arthroscopic Meniscus Surgery a Placebo Effect?

MedicalResearch.com Interview with:

Jonas Bloch Thorlund Associate Professor (MSc, PhD) Department of Sports Science and Clinical Biomechanics Research Unit for Musculoskeletal Function and Physiotherapy University of Southern Denmark

Dr. Jonas Thorlund

Jonas Bloch Thorlund
Associate Professor (MSc, PhD)
Department of Sports Science and Clinical Biomechanics
Research Unit for Musculoskeletal Function and Physiotherapy
University of Southern Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Arthroscopic partial meniscectomy is a very common knee surgery. Research evidence has seriously questioned the effect of this type of surgery for degenerative meniscal tears in middle-aged and older patients. Most young patients with traumatic meniscal injury (from sports or similar) also undergo this type of surgery. There is a general understanding that young patients with traumatic tears experience larger improvements in patient reported pain, function and quality of life. However, evidence for this presumption is sparse.

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Reasons for Drug Policy Reform: Millions of People are Left with Untreated Pain

MedicalResearch.com Interview with:
Dr. Katherine Irene Pettus, PhD, OSB

Advocacy Officer International Association for Hospice and Palliative Care
Vice Chair, Vienna NGO Committee on Drugs
Secretary NGO Committee on Ageing, Geneva

MedicalResearch.com: What is the background for this study?

Response: The background for this study is analysis of the three international drug control treaties, official attendance and participation at meetings of the Commission on Narcotic Drugs for the past four years, ongoing discussion of national opioid consumption rates with INCB, and years of home hospice visits in developing countries.

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Topical Anesthetic Creams Work Best To Reduce Pain From Childhood Vaccination

MedicalResearch.com Interview with:

Dr. Anna Taddio PhD Professor in the Leslie Dan Faculty of Pharmacy University of Toronto Adjunct senior scientist and clinical pharmacist at SickKids

Dr. Anna Taddio

Dr. Anna Taddio PhD
Professor in the Leslie Dan Faculty of Pharmacy
University of Toronto
Adjunct senior scientist and clinical pharmacist at SickKids

MedicalResearch.com: What is the background for this study?
Response: We do not know enough about how well different pain interventions work over time and when combined together. In this study, we compared the effectiveness of interventions when layered together, starting from simplest to most complicated in terms of implementation, in the first year of life in infants undergoing routine vaccinations.

We compared 4 different treatments:
1. placebo (sham),
2. Educational video for parents about how to soothe their infants,
3) video and sucrose (sugar water),
4) video and sucrose and liposomal lidocaine cream.

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Smoking Reduces Surgical Improvement for Cervical Myelopathy

MedicalResearch.com Interview with:

Dr. David Kusin MD University of Nebraska Medical Center Omaha

Dr. David Kusin

Dr. David Kusin MD
University of Nebraska Medical Center
Omaha

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There is a wealth of research showing that cigarette smoking impairs healing through various mechanisms, including microvascular injury. Some evidence also suggests that tobacco use results in direct neurological injury to the peripheral and central nervous systems. Many studies have also shown that smoking reduces fusion rates and time to fusion in orthopedic surgery, including cervical surgery. Prior to our work, only a few high quality studies had been conducted to investigate prognostic factors in patients undergoing surgery for cervical myelopathy, and these identified smoking as a risk factor for a poorer outcome. The purpose of our study was to investigate this relationship further.

We conducted a retrospective cohort study of 87 nonsmokers and 47 smokers and correlated postoperative change in Nurick score (a measure of severity of cervical myelopathy from 0-5 with 5 being the worst) with smoking status. After controlling for age, sex, diabetes, duration of preoperative symptoms, severity of preoperative symptoms, signal change on MRI, surgical approach, number of spinal levels operated on, and alcohol use, we found that smokers had a significantly decreased improvement in Nurick score. Nonsmokers improved by 1.5 points whereas smokers only improved by 0.6 points. We also found that this was a dose response relationship, such that those with a history of greater tobacco use by pack years or packs per day had a greater decrease in improvement postoperatively. Interestingly, we found no correlation between tobacco use and preoperative severity of symptoms.

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Liposomal Bupivacaine Infiltration Reduced Costs and Opioid Use in TKA Surgery

MedicalResearch.com Interview with:
Bryan Sakamoto MD, PhD
Department of Anesthesia
Richard L. Roudebush, Veterans Affairs Medical Center
Department of Anesthesia
Indiana University School of Medicine
Indianapolis, Indiana

MedicalResearch.com: What is the background for this study?

Response: Liposomal bupivacaine is a novel extended-duration anesthetic that has recently become a popular option in total knee arthroplasty (TKA) for post-operative pain management. Although liposomal bupivacaine is widely used, it is unknown if the benefits justify the cost in the veteran population at our institution. The main purpose of this medication use study was to evaluate the cost verses benefit of using this agent in our veteran patient population.

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New Ibuprofen Formulation May Avoid Cardiac Side Effects

MedicalResearch.com Interview with:

Dr Nicholas Kirkby BHF Intermediate Fellow | Vascular Biology National Heart & Lung Institute | Imperial College London London

Dr Nicholas Kirkby

Dr Nicholas Kirkby
BHF Intermediate Fellow | Vascular Biology
National Heart & Lung Institute | Imperial College London
London

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know drugs like ibuprofen, called ‘non-steroidal anti-inflammatory drugs’ cause an increase in the risk of heart attacks. These side effects cause very real concerns for the many millions of people who rely on them. They are also the reason why there are no new drugs in this class and why they have been withdrawn (2011) for use as a preventative treatment for colon cancer. Previous research from our group suggests that L-arginine supplements may prevent the cardiovascular side effects caused by these drugs. Our findings here suggest that a particular formulations of ibuprofen, called ibuprofen arginate, which is already available in many parts of the world, can act like an L-arginine supplement and that this could potentially protect the cardiovascular system.

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Survey Attempts To Separate ‘Liking’ A Drug For Pain Relief vs Recreational Use

MedicalResearch.com Interview with:
Thomas Alfieri, PhD
Director, Medical Affairs Strategic Research
Purdue Pharma L.P.

MedicalResearch.com: What is the background for this study?

Response: When researchers assess the abuse potential of opioids, they follow current FDA guidance, which stipulates that questions such as “Do you like this drug?” and “How much would you like to take this drug again?” be asked of recreational drug users. We think that assessing abuse potential among recreational users provides useful information, however, we believe that the questions designed to be asked of recreational users are not appropriate for use with pain patients. These items can confuse the liking of a drug for pain relief with the liking of a drug to get high – two very different reasons that a pain patient might want to take a drug again. In theory, abuse potential could be overestimated among pain patients because of the somewhat general nature of the items used in the survey instrument.

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Excess Health Care Costs of Opioid Abuse Begin Well Before Initial Diagnosis

MedicalResearch.com Interview with:

Jaren Howard, PharmD, BCPS Associate Director, Medical Affairs Strategic Research Purdue Pharma L.P.

Dr. Jared Howard

Jaren Howard, PharmD, BCPS
Associate Director,
Medical Affairs Strategic Research
Purdue Pharma L.P.

MedicalResearch.com: What is the background for this study?

Response: Opioid abuse, dependence, overdose, and poisoning (referred to collectively for the purposes of this study as “abuse”) represent a costly public health concern to payers. Excess annual costs for a diagnosed opioid abuser range from $10,000-$20,000 per patient. Current literature does not sufficiently address the drivers of excess costs in terms of medical conditions driving costs or places of service.

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Persistent Postpartum Pain Linked To Higher Risk of Depression

MedicalResearch.com Interview with:
MS WEI DU, First author
Third Year Medical Student
DUKE-NUS Medical School and
DR BAN LEONG SNG, Senior Author
Senior Consultant Department of Women’s Anesthesia KK
Women’s and Children’s Hospital

MedicalResearch.com: What is the background for this study? What are the main findings?

MS WEI DU: We performed a cohort study involving 200 healthy women who received epidural pain relief during the deliveries of their firstborns to investigate the relationship between persistent childbirth pain, psychological and pain vulnerability with postnatal depression. Postnatal depression was evaluated using the Edinburgh Postnatal Depression Score (EPDS).

Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

DR BAN LEONG SNG: Patients with persistent pain (>4 weeks postpartum) had significantly higher EPDS scores as compared to patients whose pain resolved by 4 weeks by a difference of 2.44 mean score, and compared to patients who never had pain postpartum by a difference of 4.07 mean score. Other significant factors that were associated with higher EDPS score included higher levels of stress, greater pain vulnerability during the intrapartum period and higher anxiety level at 6 to 8 weeks postpartum.

MedicalResearch.com: What should readers take away from your report?

MS WEI DU: We concluded that greater pain vulnerability and stress during intrapartum period, and presence of persistent pain or higher anxiety during postpartum period are positively associated with higher scores on postnatal depression tests.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

DR BAN LEONG SNG: The research findings support the need to address pain comprehensively to lessen the risk of developing postnatal depression. We are currently conducting a larger study to evaluate the impact of pain and postnatal depression in pregnant women.

MedicalResearch.com: Is there anything else you would like to add?

DR BAN LEONG SNG: Postnatal evaluation and management of childbirth pain and postnatal depression is important in our care of mothers and their newborns.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

World Congress of Anaesthesiologists abstract discussing:

Persistent childbirth pain increases risk of postnatal depression

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

BUZZY Reduces Pain and Fear of Needle Sticks

Buzzy: Drug Free Pain Control

Buzzy: Drug Free Pain Control

MedicalResearch.com Interview with:
Amy Baxter MD
CEO MMJ Labs LLC

MedicalResearch.com: Would you tell us a little about your background? How did you develop an interest in pain management and prevention?

Amy Baxter MD CEO MMJ Labs LLC

Dr. Amy Baxter

Response: As a pediatric emergency doctor, I found it interesting that doctors could prevent pain but sometimes couldn’t be bothered to do so. The lack of empathy and impatience is built into emergency training – we learn to diagnose and fix things quickly, not comfort and support. I decided to research how pain management would make procedures more successful, or faster, to convince doctors to use pain management for THEIR benefit.

MedicalResearch.com: What is the background for the Buzzy(r) device? How does it impact pain sensation?

Response: When my 4 year old had a horrible vaccination experience, I realized that a fast effective parent-controlled option for pain relief was needed. I knew that cold running water could eliminate the pain from a burned finger using physiology called gate control. Basically, the small pain nerves run alongside big motion nerves, so if you heavily stimulate motion you scramble the pain sensation. Rubbing a bumped elbow is another good example. Vibration alone didn’t work enough for needles, but when I added ice the two sensations of cold and motion eliminated pain in 84% of seniors getting a flu shot. We got a grant from the NIH to develop and study Buzzy – it’s a palm sized vibration unit with a place on the back to attach ice “wings”, that freeze solid. You put them both where an injection will go for a minute or less, then move them “between the brain and the pain” while doing a needle procedure. There are about 14 studies on IV access or blood draws and 6 on injections, showing between 50 and 88% pain reduction.

Several studies have demonstrated that Buzzy is truly a physiologic intervention, not a distraction: it didn’t work for injections when only used for 10 seconds, too little time to block the pain nerves. But it worked really well for blood draws in severely cognitively impaired children for whom distraction wasn’t an option.

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Tai Chi Studied For Muscular Neck Pain

MedicalResearch.com Interview with:

Romy Lauche, PhD Chancellor’s Postdoctoral Research Fellow Australian Research Centre in Complementary and Integrative Medicine (ARCCIM) Faculty of Health | University of Technology Sydney

Dr. Romy Lauche

Romy Lauche, PhD
Chancellor’s Postdoctoral Research Fellow
Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Faculty of Health | University of Technology Sydney

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Many people are affected by persistent or recurrent neck pain. So far the only intervention with real benefit is exercise therapy, independent of the type of exercise used. Despite the fact that musculoskeletal disorders including back and neck pain have been found predictive of Tai Chi use, no study to date has investigated its potential in the treatment of chronic non-specific neck pain.

Our study found that 12 weeks of Tai Chi significantly reduced neck pain intensity, and improved quality of life, however no differences were found between Tai Chi and conventional neck exercises. Both interventions were well tolerated, and participants were satisfied with either intervention.

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Younger Breast Cancer Patients With Radiation and Node Dissection More Likely To Have Post-Op Pain

MedicalResearch.com Interview with:

Jason Busse PhD Department of Anesthesia Department of Clinical Epidemiology & Biostatistics McMaster University Hamilton, ON

Dr. Jason Busse

Jason Busse PhD
Department of Anesthesia
Department of Clinical Epidemiology & Biostatistics
McMaster University
Hamilton, ON

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Persistent pain after breast cancer surgery affects up to 60% of patients. Early identification of those at higher risk could help inform optimal management. We conducted a systematic review and meta-analysis of observational studies to explore factors associated with persistent pain among women who have undergone surgery for breast cancer. We found that development of persistent pain after breast cancer surgery was associated with younger age, radiotherapy, axillary lymph node dissection, greater acute postoperative pain and preoperative pain. Axillary lymph node dissection increases the absolute risk of persistent pain by 21%, and provides the only high yield target for a modifiable risk factor to prevent the development of persistent pain after breast cancer surgery.

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Chronic Pain Can Affect Over Half of Adults

MedicalResearch.com Interview with:

Dr Alan Fayaz MA MBBS MRCP FRCA FFPMRCA Consultant in Anaesthesia and Pain Medicine University College London Hospital NHS Foundation Trust

Dr. Alan Fayaz

Dr Alan Fayaz
MA MBBS MRCP FRCA FFPMRCA
Consultant in Anaesthesia and Pain Medicine
University College London Hospital NHS Foundation Trust

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Fayaz: Despite fairly well established negative consequences of chronic pain (social, psychological, biological) very little is known about the burden of chronic pain in the United Kingdom. For example healthcare costs relating to chronic pain in the USA outstrip those of Cancer and Cardiovascular disease, and yet the profile of chronic pain (as disease in its own right) is not nearly as well established as either of those conditions. Surprisingly, prior to our study, there was little consensus regarding the prevalence of chronic pain in the UK. The purpose of our review was to synthesise existing data on the prevalence of various chronic pain phenotypes, in the United Kingdom, in order to produce accurate and contemporary national estimates.

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Inflammatory Biomarker CRP Elevated in Migraine

MedicalResearch.com Interview with:

Dr. Gretchen Tietjen MD Professor and Chair of Neurology Director of UTMC Headache Treatment and Research Program Director of the UTMC Stroke Program

Dr. Gretchen Tietjen

Dr. Gretchen Tietjen MD
Professor and Chair of Neurology
Director of UTMC Headache Treatment and Research Program
Director of the UTMC Stroke Program

MedicalResearch.com: What is the background for this study?

Dr. Tietjen : C-reactive protein (CRP) is a well-established biomarker of inflammation. Elevated levels of CRP predict future cardiovascular events, such as myocardial infarction (heart attack) and stroke. Evidence linking higher CRP levels with migraine is limited and results from large population-based studies are conflicting. The National Health and Nutrition Examination Survey (NHANES) data for children and adolescents linked elevated CRP to headache, particularly in girls, and the Women’s Health Study showed an association of CRP with migraine in women over 45 years of age. In the Reykjavik study, CRP levels in persons with migraine were similar to levels in those without migraine. The aim of our study was to examine the relationship of CRP and migraine in a large population-based sample of over 9,000 young adults (24 to 32 years old) from The National Longitudinal Study of Adolescent to Adult Health (Add Health).

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Study Evaluates Electroacupuncture for Carpal Tunnel Pain

MedicalResearch.com Interview with:

Dr Vincent Chung Assistant Professor, Jockey Club School of Public Health and Primary Care Associate Director (Education), Hong Kong Institute of Integrative Medicine Registered Chinese Medicine Practitioner The Chinese University of Hong Kong

Dr. Vincent Chung

Dr Vincent Chung
Assistant Professor, Jockey Club School of Public Health and Primary Care
Associate Director (Education), Hong Kong Institute of Integrative Medicine
Registered Chinese Medicine Practitioner
The Chinese University of Hong Kong

MedicalResearch.com: What is the background for this study?

Response: Primary carpal tunnel syndrome (CTS) is one of the most common forms of peripheral entrapment neuropathy. It is a major cause of disability on the upper extremity incurring considerable limitation on daily activities among patients. Currently, there is no consensus on appropriate treatment for patients with chronic (≥6 months) mild to moderate symptoms [Archives of physical medicine and rehabilitation. 2014;95(12):2253-63].

Electroacupuncture is a common technique for managing pain and neuropathy in Chinese medicine. Current CTS treatment guidelines from the UK National Institute for Health and Care Excellence (NICE), American Academy of Orthopaedic Surgeons (AAOS) and the American College of Occupational and Environmental Medicine (ACOEM) made no specific recommendations for or against electroacupuncture.

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Anger and Stonewalling Lead To Different Medical Vulnerabilities

MedicalResearch.com Interview with:

Robert W. Levenson, Ph.D. Professor, Department of Psychology Director, Institute of Personality and Social Research (IPSR) University of California Berkeley, CA

Dr. Robert Levenson

Robert W. Levenson, Ph.D.
Professor, Department of Psychology
Director, Institute of Personality
and Social Research (IPSR)
University of California
Berkeley, CA

MedicalResearch.com: What is the background for this study?

Dr. Levenson: This study comes from a 20-year longitudinal study of Bay Area married couples that we began in the late 1980s. The main purpose of the study was to understand the emotional qualities of successful marriages. Couples came to our laboratory every five years so that we could get a snapshot of the way they interacted with each. We also measured their psychological and physical health. This new paper connects the emotional behaviors we observed when couples discussed a problem in their marriage at the start of the study with the kinds of illnesses they developed over the ensuing decades.
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New Drug Candidate Aims To Treat Both Pain and Opioid Addiction

MedicalResearch.com Interview with:

Richard M. Mangano, PhD Chief Scientific Officer at Relmada Therapeutics

Dr. Richard Mangano

Richard M. Mangano, PhD
Chief Scientific Officer at Relmada Therapeutics

Dr. Mangano has extensive experience leading global R&D programs in both large and small pharmaceutical companies including positions in discovery and clinical research at Hoffmann-La Roche, Lederle Laboratories, Wyeth Research and Adolor Corporation. He served as acting Therapeutic Area Director for Neuroscience at Wyeth before joining Adolor as Vice President of Clinical Research and Development. Dr. Mangano’s expertise includes multiple IND/CTC submissions and NDA/MAA approvals in psychiatry, neurology and gastrointestinal therapeutic areas. Dr. Mangano is also an adjunct professor in the Department of Pharmacology and Physiology at the Drexel University School of Medicine. He lectures in the Drug Discovery and Development Program and in the Psychiatry Department’s Resident Training Program.  He has authored 30 peer reviewed publications and over 120 abstracts and presentations. Dr. Mangano holds a B.S degree in Chemistry from Iona College and a PhD degree in Biochemistry from Fordham University. Prior to joining the pharmaceutical industry, he was a research faculty member of the Maryland Psychiatric Research Institute at the University of Maryland School of Medicine.

Dr. Mangano discusses the opioid addiction and the development of abuse-resistant medications.

MedicalResearch.com: What is the background for the development of abuse-resistant medications? How extensive is the problem of opioid addiction?

Dr. Mangano: Recognizing the growing incidence of opioid abuse, misuse, and overdose in the United States, pharmaceutical companies, with the guidance of the FDA, are developing products that can mitigate abuse, while recognizing the importance of maintaining the availability of opioid analgesics for the millions of patients in this country who suffer from pain.

Approximately two million people in the U.S. are addicted to opioids. The market for products that treat opioid dependence has grown significantly due to the rapidly escalating problem of prescription opioid misuse and abuse, a recent resurgence of heroin use, and the growing number of physicians treating opioid dependence.

One of our product candidates, REL-1028 (BuTab), is a proprietary formulation of buprenorphine designed to treat both opioid addiction and moderate to severe chronic pain. Although there is the potential for addiction to buprenorphine, the risk is lower because it is a “partial agonist” of the mu opioid receptor compared with “full agonist” opioids like heroin, morphine, oxycodone, and hydrocodone. As a result, products containing buprenorphine, such as BuTab, should have reduced risk of abuse and physical dependence and would be controlled in Schedule III of the Controlled Substances Act (as opposed to the more restrictive Schedule II). We are also considering a formulation that would include an opioid antagonist that would not interfere with analgesia when taken orally as prescribed but would block the action of buprenorphine if it were to be inhaled or injected.

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Taking Acetaminophen Reduces Empathy For Others

MedicalResearch.com Interview with:

Dominik Mischkowski, co-author of the study Former Ph.D. student at Ohio State Now at the National Institutes of Health

Dr. Dominik Mischkowski

Dominik Mischkowski, co-author of the study
Former Ph.D. student at Ohio State
Now at the National Institutes of Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Mischkowski: We tested in two double blind experiments whether the popular physical painkiller acetaminophen reduces empathy for the pain of other people. In the first experiment (N=80), participants completed measures of empathy (i.e., perceived pain and personal distress) while reading hypothetical about the physical and social mishaps of other people. We found that acetaminophen reduced empathy for pain in these scenarios. In Study 2 (N=114), we replicated and extending these findings, showing that acetaminophen also decreased empathy (i.e., perceived pain, personal distress, and empathic concern) for another study participant experiencing ostracism or painful noise blasts. Furthermore, noise unpleasantness accounted for the effect of acetaminophen on empathy for noise pain.

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Gene Therapy to Spinal Cord Offers Potential Hope to Peripheral Nerve Pain Patients

MedicalResearch.com Interview with:

Hui-Lin Pan, MD, PhD Helen T. Hawkins Distinguished Professor  and Deputy Division Head for Research Division of Anesthesiology and Critical Care, Unit 110 The University of Texas MD Anderson Cancer Center Houston, TX

Dr. Hui-Lin Pan

Hui-Lin Pan, MD, PhD
Helen T. Hawkins Distinguished Professor
and Deputy Division Head for Research
Division of Anesthesiology and Critical Care, Unit 110
The University of Texas MD Anderson Cancer Center
Houston, TX

MedicalResearch.com: What is the background for this study?

Dr. Hui-Lin Pan: Chronic nerve pain caused by damage to the peripheral nerve is a debilitating health problem and remains very difficult to treat. Sensory neurons in the spinal cord are normally inhibited by inhibitory neurotransmitters (GABA and glycine) to regulate transmission of painful information. A major feature of nerve injury-induced chronic pain is reduced spinal cord inhibition, resulting from diminished activity of a chloride transporter called KCC2. In this study, we investigated whether increasing KCC2 expression at the spinal level using a lentiviral vector can restore KCC2 activity, thereby reducing chronic nerve pain.

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Joint Pain and Physical Function Commonly Improve after Bariatric Surgery

MedicalResearch.com Interview with:

Wendy King, PhD Associate Professor of Epidemiology Epidemiology Data Center, Room 105 University of Pittsburgh Pittsburgh, PA 15213

Dr. Wendy King

Wendy King, PhD
Associate Professor of Epidemiology
Epidemiology Data Center, Room 105
University of Pittsburgh
Pittsburgh, PA 15213

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. King: Severe obesity is associated with significant joint pain and impaired physical function, such as difficulty bending, lifting carrying and walking. Excess weight can lead to joint damage and accompanying pain, resulting in activity restriction and walking limitations. Obesity can also contribute to pain and physical limitations through factors such as impaired cardiorespiratory function, systematic inflammation, reduced flexibility, low strength per body mass, and depression.  Previous studies have reported significant improvements in mean values of bodily and joint specific pain, physical function, and walking capacity in the first 3-12 months following RYGB or LAGB. However, very few studies have examined the variability in response to surgery or reported on longer-term follow-up of these procedures.

My colleagues and I followed 2,221 patients participating in the Longitudinal Assessment of Bariatric Surgery-2, a large NIH-funded prospective study of adults with severe obesity undergoing weight-loss surgery at one of 10 hospitals across the U.S. Through three years of follow-up, approximately 50 to 70 % of patients who underwent bariatric surgery reported clinically important improvements in bodily pain, physical function and usual walking speed. About three-quarters of the participants with symptoms indicative of osteoarthritis before surgery experienced improvements in knee and hip pain and function. In addition, over half of participants who had a mobility deficit prior to surgery did not post-surgery. Several baseline characteristics such as younger age, male sex, higher household income, lower body mass index, fewer depressive symptoms and no history of diabetes or venous edema with ulcerations, were associated with a higher chance of improvement in pain and physical function following surgery. In addition, pre- to post-surgery reductions in weight and depressive symptoms, and remission of diabetes and venous edema with ulcerations were associated with pre- to post-surgery improvements. Thus, our findings reinforce results from shorter-term studies by addressing the durability or response and expand our understanding of the variability in response, and what factors are related to chance of improvement.

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Fentanyl Patch Prescribing Still Not Safe in 50% of Prescriptions

MedicalResearch.com Interview with:

Shawn Bugden B.Sc. (Pharm), M.Sc., Pharm.D. Associate Professor College of Pharmacy, Faculty of Health Sciences University of Manitoba Winnipeg, Manitoba, Canada R3E 0T5

Dr. Bugden

Shawn Bugden B.Sc. (Pharm), M.Sc., Pharm.D.
Associate Professor
College of Pharmacy, Faculty of Health Sciences
University of Manitoba
Winnipeg, Manitoba, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Bugden: Fentanyl is 100 times more potent than morphine.  While there has been a great deal of attention to fentanyl deaths associated with substance abuse, our study focused on the safety of fentanyl use in standard medical practice.   Fentanyl is most commonly prescribed as a transdermal (skin) patch that delivers the medication over 3 days. The product monograph and numerous safety warnings (FDA, Health Canada…) make it clear that fentanyl patches should not be used unless the patient has had considerable previous opioid exposure (more than 60mg morphine per day for more than 1 week).  Failure to heed these warnings may result in opioid overdose, respiratory depression and death.

This study examined over 11 000 first prescriptions for fentanyl patches over a 12-year period to determine if patients had received adequate exposure to opioids.  Overall 74.1% of first prescriptions were filled by patients who had not received adequate prior opioid exposure. An improvement was seen over the study period but even at the end of the study, 50% of prescriptions would be classed as unsafe.  More than a quarter (26.3%) of fentanyl prescriptions were given to patients who were completely opioid naïve and had no exposure to opioids of any kind in the previous 60 days.  Older adults, who may be more sensitive to the effects of fentanyl overdose, were more likely to receive unsafe prescriptions than younger adults.

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Mindfulness Training May Be Effective For Some Chronic Low Back Pain

MedicalResearch.com Interview with:

Dr. Daniel C. Cherkin PhD Senior Investigator Group Health Research Institute Seattle, WA

Dr. Daniel Cherkin

Dr. Daniel C. Cherkin PhD
Senior Investigator
Group Health Research Institute
Seattle, WA

MedicalResearch.com: What is the background for this study?

Dr. Cherkin: Chronic low back pain is a widespread, costly, and potentially disabling problem. It’s the most common cause of pain of any kind. It affects eight in 10 Americans at some point in their lives. In recent years, the United States has been spending more on back pain treatments—but unfortunately with worse results in how much pain bothers people and interferes with their lives. Group Health is addressing the problem in several ways, including this innovative research.

MedicalResearch.com: What are the main findings?

Dr. Cherkin: In a randomized controlled trial involving more than 300 patients at Group Health, we found that training in a kind of mindfulness meditation—mindfulness-based stress reduction (MBSR)—led to meaningful improvements in functioning and chronic low back pain at six months and one year. MBSR, which is becoming increasingly popular and available in the United States, involves training in observing, acknowledging, and accepting thoughts and feelings including pain. The training also includes some easy yoga poses to help participants become more aware of their bodies. Results with  mindfulness-based stress reduction were significantly better than with usual care (whatever patients would be doing for their back pain if they weren’t in the study, including medications and physical therapy—but not mindfulness meditation or cognitive behavioral therapy). And results with  mindfulness-based stress reduction were very similar to those with cognitive behavioral therapy (CBT). CBT includes education about chronic pain, relationships between thoughts and emotional and physical reactions, instruction and practice in changing dysfunctional thoughts, setting and working towards behavioral goals, relaxation skills, activity pacing, and pain coping strategies. Prior studies had already proven that CBT helped adults of various ages with back pain.

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Epidural Steroid Injections May Reduce Costs As Well As Pain

MedicalResearch.com Interview with:

Eric Sun, MD/PhD Instructor Department of Anesthesiology, Perioperative and Pain Medicine Stanford University

Dr. Eric Sun

Eric Sun, MD/PhD
Instructor
Department of Anesthesiology, Perioperative and Pain Medicine
Stanford University

MedicalResearch.com: What is the background for this study? 

Dr. Sun: Epidural steroid injections are frequently used to treat chronic low back pain.  While previous studies have shown they are effective at improving symptoms, whether they reduce spending is unknown.  These concerns are particularly salient because insurers are worried that epidural steroid injections are being overused.

MedicalResearch.com: What are the main findings?

Dr. Sun: Overall, we find that epidural steroid injections were associated with decreases in spending ranging from five to fifteen percent, depending on the specific indication.  These differences were largely driven by decreases in outpatient spending (e.g., spending on outpatient physician visits).

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Botulinum Toxin A Injections Helpful For Some Patients With Peripheral Neuropathic Pain

MedicalResearch.com Interview with:
Nadine Attal, MD PhD
Professeur associée de l’UVSQ
INSERM U 987 et CETD
CHU Ambroise Paré
92100 Boulogne-Billancourt

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Attal: The background for this study is based on the findings of experimental studies in animals and healthy subjects indicating that botulinum toxin type A  (BTX-A) may have analgesic activity independent of its effect on muscle tone.

BTX-A has been reported to have analgesic effects against peripheral neuropathic pain in prior trials, but the quality of the evidence was generally low, as it was derived mostly from small pilot studies and no study has evaluated the relevance of repeated administrations for the treatment of NP. Furthermore, the clinical profiles of the patients responding to BTX-A have not been fully characterized.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Attal: They should take away that two repeated subcutaneous administrations of botulinum toxin type A are effective in peripheral  neuropathic pain but mostly in patients with allodynia and/or limited thermal deficits. BTX-A also appears to be particularly effective on paroxysmal pain (ie electric shock like pain).

Finally, the efficacy of a second administration of BTX-A is enhanced over the first injection.

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Blacks and White Patients Perceive and Cope With Pain Differently

MedicalResearch.com Interview with:

Adam T. Hirsh PhD Assistant Professor, Psychology Indiana University Indianapolis, IN

Dr. Adam T. Hirsh

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.

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Depression Can Recur After Opioids Initiated For Non-Cancer Pain

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.

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For Many Women, Migraines Worsen During Menopause

Dr. Vincent Martin, MD Professor of Internal Medicine University of Cincinnati College of Medicine Cincinnati OH

Dr. Martin

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.

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Acupuncture No Better Than Placebo For Hot Flashes

Acupuncture-Wikipedia-Image

Acupuncture Presure

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.

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