Author Interviews, Depression, Pain Research, Psychological Science / 19.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49850" align="alignleft" width="128"]Dr. Markus Rütgen Post-doctoral researcher Social, Cognitive and Affective Neuroscience Unit Faculty of Psychology University of Vienna Dr. Ruetgen[/caption] Dr. Markus Rütgen PhD Post-doctoral researcher Social, Cognitive and Affective Neuroscience Unit Faculty of Psychology University of Vienna  MedicalResearch.com: What is the background for this study? Response: Previous research has reported empathy deficits in patients with major depressive disorder. However, a high percentage of patients taking part in these studies were taking antidepressants, which are known to influence emotion processing. In our study, we wanted to overcome this important limitation. We were interested in whether the previously reported empathic deficits were attributable to the acute state of depression, or to the antidepressant treatment. To this end, we performed a longitudinal neuroimaging study, in which we measured brain activity and self-reported empathy in response to short video clips showing people in pain. We measured acutely depressed patients twice. First, before they started their treatment, second, after three months of treatment with a state-of-the-art antidepressant (selective serotonin reuptake inhibitors).
Annals Internal Medicine, Author Interviews, Opiods, University of Pittsburgh / 18.06.2019

MedicalResearch.com Interview with: [caption id="attachment_49771" align="alignleft" width="130"]Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh Dr. Donohue[/caption] Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: The opioid epidemic is exacting a significant burden on families, communities and health systems across the U.S. Prescription and illicit opioids are responsible for the highest drug overdose mortality rates ever recorded. We know from previous studies that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until our study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital. My colleagues and I reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014. Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average.
Anesthesiology, Author Interviews, Duke, OBGYNE, Opiods, Pain Research, Surgical Research / 29.05.2019

MedicalResearch.com Interview with: Ashraf Habib, MDChief of the Division of Women’s Anesthesia and Professor of AnesthesiologyDuke University Ashraf Habib, MD Chief of the Division of Women’s Anesthesia Professor of Anesthesiology Duke University  MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was a multicenter study conducted in 13 clinical sites in the United States enrolling patients undergoing elective Cesarean-section and receiving spinal anesthesia. 186 patients were enrolled and randomized to receive EXPAREL, a long-acting, non-opioid option to manage postsurgical pain, administered via transversus abdominis plane (TAP) field block, mixed with plain bupivacaine or TAP block with plain bupivacaine alone. A TAP block numbs the nerves that supply the abdominal wall. We presented the data at the 51st Annual Meeting of the Society of Obstetric Anesthesia and Perinatology (SOAP) in Phoenix, AZ. We aimed to collect clinical evidence that a multimodal postsurgical pain regimen using a TAP block with EXPAREL (bupivacaine liposome injectable suspension) together with regularly scheduled acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) could reduce opioid consumption more so than a standard multimodal pain control approach that combines TAP block with standard bupivacaine, regularly scheduled acetaminophen, and NSAIDs.
Author Interviews, Brigham & Women's - Harvard, Opiods, Orthopedics, Pain Research, Surgical Research / 16.05.2019

MedicalResearch.com Interview with: [caption id="attachment_49201" align="alignleft" width="135"]Marilyn M. Heng, MD, MPH, FRCSCOrthopaedic Trauma SurgeonAssistant Professor of Orthopaedic SurgeryHarvard Medical School Dr. Heng[/caption] Marilyn M. Heng, MD, MPH, FRCSC Orthopaedic Trauma Surgeon Assistant Professor of Orthopaedic Surgery Harvard Medical School  MedicalResearch.com: What is the background for this study?   Response: The ultimate background for this study does come from the larger context of the opioid epidemic that is seen worldwide but particularly in North America. Orthopaedic surgeons should take responsibility as being among the top prescribers of opioids. The more specific background that led to this specific study was the observation that several colleagues would insist that a drug like hydromorphone was so dangerous that they would not prescribe it but seemed okay prescribing large amounts of oxycodone.  It seemed like an urban myth that the type of opioid was what made it dangerous, so that led us to do the study to see if there was evidence for that. 
Author Interviews, Opiods, Pain Research / 06.05.2019

MedicalResearch.com Interview with: [caption id="attachment_48970" align="alignleft" width="200"]Jan Klimas, PhD, MScSenior Postdoctoral FellowBC Centre on Substance Use (BCCSU) Vancouver, BC Dr. Klimas[/caption] Jan Klimas, PhD, MSc Senior Postdoctoral Fellow BC Centre on Substance Use (BCCSU) Vancouver, BC MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Some individuals prescribed opioid analgesic medications for pain develop opioid use disorder. So, much research has been conducted to develop strategies to identify patients who can be safely prescribed opioid analgesics. However, this research has not been critically reviewed through rigorous quality assessment. This study therefore sought to identify signs, symptoms & screening tools to identify patients with pain who can be safely prescribed opioids 
Author Interviews, ENT, JAMA, Pain Research, Pediatrics, Surgical Research / 05.04.2019

MedicalResearch.com Interview with: [caption id="attachment_48406" align="alignleft" width="133"]Gillian R. Diercks, MD, MPHInstructor in Otolaryngology, Harvard Medical SchoolDepartment of OtolaryngologyMassachusetts Eye and Ear InfirmaryBoston, Massachusetts Dr. Diercks[/caption] Gillian R. Diercks, MD, MPH Instructor in Otolaryngology, Harvard Medical School Department of Otolaryngology Massachusetts Eye and Ear Infirmary Boston, Massachusetts  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Pediatric tonsillectomy is a commonly performed procedure, representing the second most common ambulatory surgery performed on children in the United States, with over half a million children undergoing the surgery annually.  A major concern for surgeons, patients, and their families is the issue of postoperative pain control as pain can last up to 10-14 days after surgery, be quite severe, and result in readmission to the hospital or ED visits for medications and dehydration. In young children and children with sleep apnea we cannot safely administer narcotic pain medications at home.  This leaves limited options for pain control, including acetaminophen and ibuprofen.  However, there are concerns that ibuprofen could potentially increase bleeding risk after surgery because of its effects on platelet function in the blood.  At baseline, the risk of postoperative hemorrhage within the first two weeks after tonsillectomy is around 4.5%, with about 1-1.5% of children requiring a return to the operating room to control severe bleeding.  Our study set out to show that the risk of severe postoperative bleeding when ibuprofen is given for 9 days after tonsillectomy was not increased compared with the bleeding risk when acetaminophen was administered instead. Our study could not conclude that the risk of bleeding is no different when ibuprofen is used, and was suggestive that the bleeding risk may actually be higher.
Author Interviews, Orthopedics, Pain Research / 19.03.2019

MedicalResearch.com Interview with: [caption id="attachment_47992" align="alignleft" width="122"]Geoffrey Westrich, MDDirector of ResearchAdult Reconstruction and Joint Replacement ServiceHospital for Special SurgeryNYC Dr. Westrich[/caption] Geoffrey Westrich, MD Director of Research Adult Reconstruction and Joint Replacement Service Hospital for Special Surgery NYC  MedicalResearch.com: What is the background for this study? Response: Recent mortality trends in the U.S. associated with opioid use disorders have brought to the forefront of national debate the desirability of minimizing the use of potentially addictive pain management therapies.  Pain management after hip replacement surgery is an important part of patient care, and  opioids are frequently given as a major part of postoperative pain management. At the same time, multimodal analgesia, the administration of anesthetic agents and medications agents targeting multiple pain pathways, has seen increased popularity in pain management after hip replacement surgery.  At Hospital for Special Surgery (HSS), the multimodal protocol entails the use of several different anesthetic agents and medications both during and after surgery to control pain, minimize the use of opioids and reduce side effects. The use of non-opioid analgesics such as acetaminophen allows for a reduction in opioid administration after surgery [1]. Acetaminophen, commonly known as Tylenol, has traditionally been administered orally, but more recently an intravenous (IV) preparation has become available.  IV acetaminophen after major orthopedic surgery was shown to provide effective analgesia and reduce morphine administration by 33%, compared to placebo [2]. Unless a patient is unable to take acetaminophen, it is commonly used as part of the multimodal protocol due to its efficacy and minimal contraindications. Although intravenous (IV) acetaminophen presents pharmacokinetic benefits, such as increasing both serum blood and cerebrospinal fluid levels more rapidly, there is limited analysis of its potential clinical advantages compared to oral acetaminophen.  We hypothesized that there could be a reduction in pain with activity, opioid usage, or opioid- related side effects among patients receiving IV acetaminophen compared to oral acetaminophen following hip replacement surgery 
Author Interviews, CDC, JAMA, Opiods / 12.02.2019

MedicalResearch.com Interview with: [caption id="attachment_32722" align="alignleft" width="200"]Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury CDC Dr. Gery Guy[/caption] Gery Guy, PhD, MPH Injury Center CDC MedicalResearch.com: What is the background for this study? Response: This study examined opioid prescribing at the national and county-level in 2015 and 2017. During 2015 to 2017, the amount of opioids prescribed decreased 20.1% in the United States. The amount of opioids prescribed per person varies substantially at the county-level. The average amount of opioids prescribed in the highest quartile of counties was nearly 6 times the amount in the lowest quartile. Reductions in opioid prescribing could be related to policies and strategies aimed at reducing inappropriate prescribing, increased awareness of the risks associated with opioids, and release of the CDC Guideline for Prescribing Opioids for Chronic Pain.
Author Interviews, Pain Research, Stroke / 04.02.2019

MedicalResearch.com Interview with [caption id="attachment_47315" align="alignleft" width="160"]Michelle Androulakis, MD, MS, FAHS Chief of Neurology WJB Dorn VA Medical Center and Faculty at University of South Carolina. Columbia, SC Dr. Androulakis[/caption] Michelle Androulakis, MD, MS, FAHS Chief of Neurology WJB Dorn VA Medical Center and Faculty at University of South Carolina. Columbia, SC MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Even though Migraine with aura was associated with an increased risk of ischemic stroke in the Atherosclerosis Risk in Communities study (ARIC), our post-hoc showed unexpected results that onset of such migraines before age 50 years is not associated with such risk. Instead, later onset of migraine with aura after age of 50 was linked with a higher risk of ischemic stroke. Total of 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 participants were included in the analysis. There was a two-fold increased risk of ischemic stroke when the age of migraineurs with aura onset was 50 years or older as compared with no headache participants, MO was not associated with increased stroke risk regardless of age of onset. 
Author Interviews, JAMA, Orthopedics, Pain Research, University of Pittsburgh / 09.01.2019

MedicalResearch.com Interview with: [caption id="attachment_46849" align="alignleft" width="200"]Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences  University of Pittsburgh Dr. Schneider[/caption] Dr. Michael Schneider DC, PhD Associate Professor School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: Lumbar spinal stenosis (LSS) is one of the fastest growing problems in the country due to its aging population. One third of Medicare users have the condition, and it is the number one reason for spine surgery in this population. Existing research evaluates the benefits of nonsurgical treatment options compared to surgery, but there was no existing research that compared the available nonsurgical options to each other to determine the best course of treatment for each patient. We studied three nonsurgical treatments for LSS: medical management with medications and/or epidural injections, individualized care with a physical therapist or chiropractor, and group exercise. We assessed each of these treatment methods with a questionnaire, a walking distance test, and a physical activity monitor. 
Author Interviews, Exercise - Fitness, Pain Research / 13.11.2018

MedicalResearch.com Interview with: Ms Lynne Gaskell MSc University of Salford Manchester UK MedicalResearch.com: What is the background for this study? Response: Musculoskeletal Pain as a result of common problems affecting the back, neck, shoulder, knee and multi-site pain is an increasing cause of reduced function and quality of life, and ever increasing demands on healthcare, Prognosis is often poor with many people reporting persistent symptoms after consulting their primary care practitioner. The likelihood of persistent and recurrent clinical symptoms may accentuate the physical, psychological, and social impacts of musculoskeletal pain particularly with the middle aged and elderly populations. Pilates is an exercise approach that has become increasingly popular in recent years and includes over fifty different exercises to improve flexibility, balance, core strength, core stability. It can therefore can be individualised for people with different needs, preferences, musculoskeletal conditions, ages and abilities. Aligning exercise to patient’s functional needs has been linked to long-term exercise adherence. Many physiotherapists such as sydney physio solutions have started to specialise in this as a form of treatment, click here for more info on pilates and the many benefits they can have on your physical health. This study investigated the personal experiences and perceptions of the impact of Pilates on the day-to-day lives of adults with a myriad of chronic MSK conditions following a 12 week Pilates Exercise Programme.The results were organised into five main themes: 1. Physical Improvements strength, core stability, flexibility and balance. 2. Pilates Promotes an Active Lifestyle and improved performance at work and / or hobbies. 3. Psychosocial benefits and improved confidence, 4. Increased Autonomy in Managing their own Musculoskeletal Condition and 5. Motivation to continue with exercise.
Author Interviews, MRI, Pain Research, Rheumatology / 11.10.2018

MedicalResearch.com Interview with: Daniel S. Albrecht, Ph.D. Research Fellow, Department of Radiology Harvard Medical School MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by fibromyalgia? Response: Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, unrefreshing sleep, memory deficits and attention difficulties, among other symptoms. FM affects an estimated 4 million adults in the U.S., but despite this prevalence, effective therapies for treating FM are lacking. [caption id="attachment_45185" align="aligncenter" width="400"]This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers. Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers.
Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital[/caption] Part of the reason for the paucity of effective therapeutics is insufficient knowledge of the underlying mechanisms contributing to FM. Previous work from co-senior author of the current manuscript, Eva Kosek, MD, PhD, and collaborators at the Karolinska Institute in Sweden found elevated inflammatory molecules in the cerebrospinal fluid of FM patients, which could be reflective of brain neuroinflammation in these patients. However, no study had directly assessed the presence of neuroinflammation in the brain of FM patients. Co-senior author of the study, Marco Loggia, PhD, and collaborators showed in a 2015 Brain publication that individuals with chronic low back pain (cLBP) exhibit evidence of brain neuroinflammation, specifically activation of glial cells. Our team utilized simultaneous MR/PET imaging to image brain levels of the 18 kDa translocator protein (TSPO), which is widely used as a marker of glial activation due to vast upregulation of TSPO in glial cells, e.g. microglia and astrocytes, in preclinical models of inflammation and neurological disease. Dr. Loggia sought to extend these finding in cLBP to FM, hypothesizing that activation of glial cells may also be associated with FM pathology. To this end, we used the same TSPO PET tracer to image 20 FM patients and 16 healthy controls. During a conference where I was presenting preliminary results of the fibromyalgia study, Dr. Loggia met with Dr. Kosek and discovered that, across the Atlantic, her group was performing a very similar study, imaging 11 FM patients and 11 controls with the same TSPO PET compound. They decided to form a collaboration, and logistic talks began to determine the best strategy to combine and analyze the separate datasets. In addition to PET imaging with the TSPO tracer, which is suggested to reflect activated microglia and astrocytes, Dr. Kosek’s group also collected PET scans using a tracer thought to bind specifically to astrocytes rather than microglia. This tracer was used in order to discern the relative contributions of microglia and astrocytes to any observed differences in TSPO PET signal.
Author Interviews, Neurology, Pain Research / 25.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44791" align="alignleft" width="172"]John Douglas Markman, M.D. Director, Translational Pain Research Program Department of Neurosurgery Associate Professor University of Rochester School of Medicine and Dentistry Dr. Markman[/caption] John Douglas Markman, M.D. Director, Translational Pain Research Program Department of Neurosurgery Professor University of Rochester School of Medicine and Dentistry  MedicalResearch.com: What is the background for this study? Response: Peripheral nerve injury after trauma and surgery is a leading cause of chronic pain and disability. These pain syndromes are often considered to have an underlying neuropathic mechanism because there is altered sensory processing (e.g., numbness, allodynia) at the site of trauma or surgical incision that localizes to the anatomic distribution of a peripheral nerve. A previous eight-week randomized clinical trial demonstrated efficacy for pregabalin in patients with chronic post-traumatic or -surgical pain.(10) The longer duration of treatment of this study was designed to meet the regulatory standard for a chronic pain indication in the US, 12 weeks of treatment at maintenance or fixed dosing.
Author Interviews, Cannabis, Pain Research / 13.09.2018

MedicalResearch.com Interview with: Jacob M. Vigil, PhD Department of Psychology University of New Mexico MedicalResearch.com: What is the background for this study?   Response: For the past several years we have been using observational research designs as a means to overcome some of the logistical and legal barriers for conducting patient outcomes medical cannabis research. In partnership with the software developers of the Releaf App which currently is the largest repository of user-entered information on the consumption and effects of cannabis use in the United States, we have been able to measure how patients choose to consume cannabis and the effects of those choices in real-time.  Since its release in 2016, the commercially developed Releaf App has been the only publicly available, incentive-free patient educational software program designed for recording how individual cannabis usage sessions correspond to immediate changes in symptom intensity levels and experienced side effects.
Author Interviews, Pain Research, Surgical Research / 12.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44452" align="alignleft" width="148"]Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine Dr. Jonas[/caption] Wayne B. Jonas, MD Clinical Professor of Family Medicine Uniformed Services University and at Georgetown University School of Medicine MedicalResearch.com: What is the background for this study? Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.
Author Interviews, JAMA, Pain Research, Surgical Research / 09.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44355" align="alignleft" width="133"]David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  Dr. Shaye[/caption] David A. Shaye, M.D., FACS Instructor in Otolaryngology Harvard Medical School  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cosmetic and functional rhinoplasty (nasal surgery) is the most common procedure we perform and traditionally post operative pain medication includes opioids. In light of the recent opioid epidemic, we wished to investigate if patients pain was being treated over-treated by surgeons. Of 173 Rhinoplasties that we performed, the majority of patients received post operative opioid tablets (an average of 28 tablets).  However 11% of patients did not fill these prescriptions at all, and only 2 of the 178 patients required refills. We believe patients experienced less pain than surgeons anticipated.
Author Interviews, JAMA, Pain Research, Technology / 06.09.2018

MedicalResearch.com Interview with: [caption id="attachment_44273" align="alignleft" width="150"]Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento Dr. Kravitz[/caption] Richard L Kravitz, MD, MSPH Professor, General Internal Medicine Director, UC Center Sacramento MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  The study was designed to address tso problems. The first is that many patients with chronic pain struggling to find a workable regimen. The second is more general. Patient sometimes I hesitate to participate in clinical research because they right away do not see the relevance I directly to them selves. And have one trials are away I’m addressing both problems. 
Addiction, Anesthesiology, Author Interviews, Emergency Care, Pain Research / 23.07.2018

MedicalResearch.com Interview with: [caption id="attachment_43379" align="alignleft" width="120"]Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine Dr. Schwarz[/caption] Evan Schwarz, MD FACEP, FACMT Associate Professor of Emergency Medicine Medical Toxicology Fellowship Director Section Chief Medical Toxicology Advisory Dean in the Office of Student Affairs Division of Emergency Medicine Washington University School of Medicine  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Ketamine is being increasingly used in the emergency department (ED) for a variety of conditions, including as an analgesic. While its usage continues to increase, there are limited studies evaluating ketamine as an analgesic in the emergency department. Most of the studies evaluating ketamine utilized it as an adjunct to an opioid, however, multiple recommendations on blogs and other websites recommend ketamine as a single agent. The purpose of the meta-analysis was to compare the analgesic effect of ketamine compared to an opioid in adult patients presenting with acute pain to the ED. In this study, we found that ketamine was non-inferior to opioids. We also found that the number of severe adverse events to be similar between both groups.
Author Interviews, Pain Research / 16.07.2018

MedicalResearch.com Interview with: [caption id="attachment_42982" align="alignleft" width="133"]Dawn Hershman, MD, MS, FASCO Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center Dr. Hershman[/caption] Dawn Hershman, MD, MS, FASCO Professor of Medicine and Epidemiology Leader, Breast Cancer Program Herbert Irving Comprehensive Cancer Center Columbia University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Aromatase inhibitors are effective in reducing the risk of recurrence in hormone sensitive breast cancer, however they commonly cause joint pain and stiffness that can lead to early discontinuation of treatment. We know that women who stop early do not get the same benefits as those who continue for the full duration. Acupuncture has been shown to improve a variety of pain syndromes. We conducted a large multicenter trial among women with joint pain on aromatase inhibitors and randomized patients to true acupuncture, sham acupuncture and a waitlist control arm. We found that acupuncture resulted in more pain reduction than the other 2 control groups. Measuring pain can be challenging in clinical trials. We now know that a meaningful reduction for a patient is 2 points on a 10 point scale. We found that nearly 60 percent of women in the true acupuncture group experienced at least a 2-point reduction in pain, versus 33 percent of the sham acupuncture group and 31 percent of the controls. These results where highly statistically significant. 
Author Interviews, Pain Research, Rheumatology, Weight Research / 19.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42538" align="alignleft" width="200"]Wake Forest professor of Health and Exercise Science Steve Messier, Friday, June 15, 2018. Prof. Messier[/caption] Professor Steve Messier Director of the J.B. Snow Biomechanics Laboratory J.B Snow Biomechanics Laboratory Wake Forest University MedicalResearch.com: Why did you undertake this study? Response: This was a secondary analysis of the Intensive Diet and Exercise for Arthritis (IDEA) clinical trial originally published in JAMA in 2013, Volume 310, Number 12, pages 11263-1273. We were interested to see if losing 20% of your body weight had any additional benefits compared to a 10% weight loss that we previously have shown to be beneficial.
Author Interviews, Kidney Disease, Neurological Disorders, Pain Research, UCSF / 06.06.2018

MedicalResearch.com Interview with: [caption id="attachment_42216" align="alignleft" width="150"]Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center Dr. Ishida[/caption] Dr. Julie H. Ishida MD Department of Medicine, Division of Nephrology University of California, San Francisco and San Francisco Veterans Affairs Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gabapentin and pregabalin are used for the management of symptoms such as neuropathic pain, itching, and restless leg syndrome in patients receiving hemodialysis. However, hemodialysis patients may be particularly vulnerable to adverse events related to these agents, which are cleared by the kidney, but there is limited data evaluating their risk in this population. Gabapentin and pregabalin use were associated with risk for altered mental status, fall, and fracture, and in some cases, even at doses that would be considered safe for use in this population. 
Author Interviews, Pain Research, Pharmaceutical Companies / 04.06.2018

MedicalResearch.com Interview with: Zosano Pharma Dr. Peter Schmidt, MD, MSc Senior Director, medical Affairs and Clinical Development Zosano Pharma   MedicalResearch.com: What is the background for this study? What are the main findings? Response: This was a post-hoc analysis of Zosano’s pivotal efficacy trial using its adhesive dermally-applied microarray (ADAM) zolmitriptan formulation, M207. The trial found that M207 was effective versus placebo for the co-primary endpoints of pain freedom and most bothersome symptom (MBS) freedom, both at two hours. The MBS endpoint was just ratified as a new endpoint in the FDA’s February 2018 guidance for acute migraine trials. The stated aim of this new endpoint is “…to better align the study outcome with the symptom(s) of primary importance to patients…” This is logical, as a given migraine patient may not experience all four previous symptom endpoints (pain, photophobia, phonophobia, nausea).
Addiction, Author Interviews, Opiods, Pain Research / 23.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41977" align="alignleft" width="160"]Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig[/caption] Dr. Stuart Lustig, M.D., M.P.H National Medical Executive for Behavioral Health Cigna Dr. Lustig discusses Cigna’s efforts to curb the opioid epidemic. MedicalResearch.com: What is the background for the Applying American Society of Addiction Medicine Performance Measures in Commercial Health Insurance and Services Data study? Response: In 2016 Cigna announced a collaboration with the American Society of Addiction Medicine (ASAM) to improve treatment for people suffering from substance use disorders and establish performance measures and best practices for addiction treatment. Mining anonymized data from Cigna’s administrative data, Brandeis University researchers have validated a new way to hone in on trouble spots where substance use disorder treatment for opioid, alcohol and other drug dependence is suboptimal, like the way police departments use computers to identify high crime areas in need of greater scrutiny and attention. The technique uses ASAM-defined performance measures to assess substance use disorder treatment patterns, giving researchers the ability to sort through administrative data and measure to the extent to which patients being treated for opioid or alcohol use disorder are receiving and using evidenced-based medications proven to be effective in improving outcomes and retention in treatment. It also measures whether those patients received support during substance withdrawal – a critical factor in the success of addiction treatment plans. The performance measures were first tested on the Veterans’ Health Administration in 2016 and now, on data from Cigna.
Author Interviews, JAMA, Orthopedics, Pain Research / 21.05.2018

MedicalResearch.com Interview with: “Back Pain” by betterhealthosteopathy is licensed under PDM 3.0Christine Goertz DC, PhD Vice Chancellor for Research and Health Policy Palmer College of Chiropractic MedicalResearch.com: What is the background for this study? Response: Low back pain in the leading cause of physical disability worldwide, with up to 80% of US adults seeking care for this debilitating condition at some point in their lives. Low-back pain is also one of the most common causes of disability in U.S. military personnel. Although a number of studies have previously evaluated chiropractic care for low back pain, the vast majority had small sample sizes and did not study chiropractic as part of a multi-disciplinary approach to care in real world settings, including the military.
Author Interviews, Biomarkers, Brigham & Women's - Harvard, Orthopedics, Pain Research / 11.05.2018

MedicalResearch.com Interview with: “osteopathic treatment for sciatica” by betterhealthosteopathy is licensed under PDM 3.0Daniel Albrecht, PhD Research Fellow in Radiology, Harvard Medical School Research Fellow, Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: A great deal of preclinical work in animal models of pain has established that activation of peripheral immune cells or, in the central nervous system (brain and spinal cord), immune cells called “glia” (microglia and astrocytes) play a key role in the establishment and/or maintenance of persistent pain. For instance, if you pharmacologically block activation of these cells in the nervous system, you are able to reduce/inhibit/prevent pain behaviors, e.g. in animals who have received a nerve injury. This observation is very exciting, because it suggests that blocking neuroinflammation may be a viable way of treating pain. However, the evidence linking human chronic pain with neuroinflammation has so far been limited. In this study we show, for the first time, that patients with chronic sciatica (that is, back pain that shoots down the leg) demonstrate elevations in the levels of a protein called the translocator protein (TSPO) in the spinal cord and in the nerve roots. Because TSPO is a marker of neuroinflammation, our results suggest that sciatica is associated with neuroinflammation. While on average patients do show elevations in the levels of the TSPO, we also saw significant variability across individuals. Importantly, patients that show stronger elevations (in the nerve roots) were those who benefit the most from receiving a local anti-inflammatory treatment (epidural spinal injection). This makes sense: patients whose nerve roots are inflamed benefit from an anti-inflammatory treatment. Those whose nerve roots aren’t inflamed, don’t receive the same benefit. In the latter case, the source of the inflammation and pain may not be the nerve roots, but may be the spinal cord, or, as we showed in a previous paper (Loggia et al., Brain 2015), the brain. 
Author Interviews, JAMA, Pain Research, Psychological Science / 07.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41491" align="alignleft" width="131"]Dr. M. Carrington Reid, MD PhD Associate Professor of Medicine Irving Sherwood Wright Associate Professor in Geriatrics Joachim Silbermann Family Clinical Scholar in Geriatric Palliative Care Joan and Sanford I. Weill Department of Medicine Weill Cornell Medical College  Dr. Reid[/caption] Dr. M. Carrington Reid, MD PhD Associate Professor of Medicine Irving Sherwood Wright Associate Professor in Geriatrics Joachim Silbermann Family Clinical Scholar Geriatric Palliative Care Joan and Sanford I. Weill Department of Medicine Weill Cornell Medical College MedicalResearch.com: What is the background for this study?   Response: Major guidelines (American College of Physicians, Centers for Disease Control, Veterans Administration) on the management of chronic pain strongly encourage clinicians to use nonpharmacologic approaches to include psychological therapies when managing pain. While many studies have evaluated psychological therapies such as cognitive behavioral theraphy (CBT) in nonelderly populations with chronic pain, far fewer have evaluated these treatments in studies of older adults. We identified 22 randomized controlled trials that evaluated a psychological therapy for chronic pain in older adults and examined the impact of these treatments on salient outcomes to include ability to reduce pain and pain-related disability, improve patients' self efficacy to manage pain, and improve their physical health and function and their psychological health (by reducing rates of anxiety and depression).
Author Interviews, Brigham & Women's - Harvard, Emergency Care, Pain Research / 07.05.2018

MedicalResearch.com Interview with: [caption id="attachment_41533" align="alignleft" width="200"]Paul B. Rizzoli, M.D., FAAN, FAHS Department of Neurology Brigham and Women’s Hospital Clinical and Fellowship Director, John R Graham Headache Center Brigham and Women’s Faulkner Hospital Assistant Professor of Neurology Harvard Medical School Dr. Rizzoli[/caption] Paul B. Rizzoli, M.D., FAAN, FAHS Department of Neurology Brigham and Women’s Hospital Clinical and Fellowship Director, John R Graham Headache Center Brigham and Women’s Faulkner Hospital Assistant Professor of Neurology Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Migraine and other recurrent headache disorders disproportionately affect otherwise healthy, middle-aged people, particularly women, and are a leading cause of suffering and disability. Accurate epidemiologic information is vital for providers, researchers and policy makers. In this paper we surveyed the most recent data from population-based studies in the United States to assess the burden and impact of these conditions. Our search included such sources as the National Health Interview Study (NHIS), the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Ambulatory Medical Care Survey (NAMCS). We found that the prevalence and burden of self-reported migraine and other severe headache has remained stable but high in the past 19 years, affecting roughly 1 out of every 6 Americans (15.3%) and 1 in 5 women (20.7%) over a 3-month period. Among other findings was that headache is proportionately more burdensome those in middle age (elderly also), those who are unemployed and those who are disabled or who have low family income. Headache represents roughly 3% of all annual emergency department visits. 
Author Interviews, Dental Research, Pain Research, University of Pittsburgh / 03.05.2018

MedicalResearch.com Interview with: “Dental Exam” by 807th Medical Command (Deployment Support) is licensed under CC BY 2.0Paul A. Moore, DMD, PhD, MPH School of Dental Medicine University of Pittsburgh  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Effective pain management is a priority in dental practice. Government and private agencies highlight the need to provide optimal pain relief, balancing potential benefits and harms of both opioid and nonopioid analgesic agents. The purpose of our study is to summarize the available evidence on the benefits and harms of analgesic agents, focusing on preexisting systematic reviews. We found combinations of ibuprofen and acetaminophen as having the highest association with treatment benefit in adult patients and the highest proportion of adult patients who experienced maximum pain relief. Diflunisal, acetaminophen, and oxycodone were found to have the longest duration of action in adult patients. Medication and medication combinations that included opioids were among those associated most frequently with acute adverse events in both child and adult-aged patient populations.
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