Osteoarthritis: Poor Sleep Linked to More Pain

PainRelief.com Interview with:
Dr. Daniel Whibley PhD
Department of Physical Medicine and Rehabilitation
University of Michigan, Ann Arbor, Michigan
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
University of Aberdeen, Scotland, UK

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

Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.

We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening,  these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.

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Study Tests Pain Relief by Coating Joint Implants with Pain Medication

PainRelief.com Interview with:

Ebru Oral, PhD
Associate Professor, Orthopaedic Surgery
Associate Director, Harris Orthopaedic Laboratory
Massachusetts General Hospital, Boston, MA,
Harvard Medical School, Cambridge, MA

Ebru Oral, PhD Associate Professor, Orthopaedic Surgery Associate Director, Harris Orthopaedic Laboratory Massachusetts General Hospital, Boston, MA, Harvard Medical School, Cambridge, MA
Dr. Oral

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

Response: This study focuses on the possibility of delivering analgesics from the polymeric implant surfaces used in total joint arthroplasty. Currently, there are multi-modal regimens for controlling pain during and after surgery, including peri-articular injections and systemic medications.

The study shows that it is possible to accomplish the delivery of the commonly used drug bupivacaine from the implants at relevant concentrations. The long-term goal is to provide this material as a tool in controlling pain locally so that the use of systemic opioid medications can be decreased.

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Low Back Pain Incidence Varies by Occupation

PainRelief.com Interview with:

Sara E. Luckhaupt, MD, MPH
Medical Officer (Epidemiologist)
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
CDR, US Public Health Service

ara E. Luckhaupt, MD, MPHMedical Officer (Epidemiologist)
 National Institute for Occupational Safety and Health
 Centers for Disease Control and Prevention
 CDR, US Public Health Service

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

  • In 2015, 26.4% of U.S. workers (nearly 40 million people) reported experiencing any low back pain (LBP) in the past 3 months; frequent and severe low back pain was reported by 8.1% of workers.
  • Many of these cases (more than 20%) were attributed to work by a health professional, but most workers affected did not discuss work-relatedness with their providers.
  • Regardless of the cause, low back pain affected many current workers’ ability to work.
  • 16.9% of workers with any low back pain and 19.0% of those with frequent and severe low back pain missed at least 1 full day of work in the past 3 months because of LBP.
  • 6.1% of workers with any low back pain and 10.7% of those with frequent and severe LBP had stopped working, changed jobs, or made a major change in work activities in the past 3 months because of their LBP
  • The burden of low back pain among workers varied by occupational group.
  • The proportion of workers who reported any low back pain and work-related LBP was highest in construction and extraction occupations; 31.6 percent of these workers reported any low back pain and 12.3% reported work-related LBP.
  • The proportion of workers reporting frequent and severe low back pain was highest in building and grounds cleaning and maintenance occupations; 11.4% of these workers reported frequent and severe low back pain .

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

  • Low back pain among workers is a substantial problem.
  • Many cases of low back pain among workers have been attributed to work, but work-relatedness may be under-recognized.
  • Identifying an association with work may improve the chances of a patient’s recovery if an aspect of their job contributing to the pain can be reduced or eliminated.

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

  • We did not examine the relationship between obesity and low back pain in our study but low back pain has been found to be associated with obesity in other studies.  Other research in this area could be helpful.
  • Future research could also examine which aspects of various jobs are most highly associated with LBP and best practices for healthcare providers to recognize and address work-related low back pain .

Citation:

Prevalence, Recognition of Work-Relatedness, and Effect on Work of Low Back Pain Among U.S. Workers

Sara E. Luckhaupt, MD, MPH; James M. Dahlhamer, PhD; Gabriella T. Gonzales, BS; Ming-Lun Lu, PhD; Matthew Groenewold, PhD; Marie Haring Sweeney, PhD; Brian W. Ward, PhD

Published: Ann Intern Med. 2019.

DOI: 10.7326/M18-3602

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Painful Genital Condition in Women Linked to Tight Jeans, Hair Removal

PainRelief.com Interview with:

Bernard L Harlow, Ph.D.
Professor, Boston University School of Public Health
Adjunct Mayo Professor, University of Minnesota School of Public Health

Bernard L Harlow, Ph.D.
Professor, Boston University School of Public Health
Adjunct Mayo Professor, University of Minnesota School of Public Health

PainRelief.comWould you briefly explain what is meant by vulvodynia?

Response: Vulvodynia is a chronic pain condition characterized by debilitating vulvar discomfort due to burning pain or pain on contact that occurs in the absence of clinically visible pathological findings or other identifiable disorders. It is estimated to affect approximately 8% of women by the age of 40 based on our previous research.

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

Response: Little is known about this debilitating pain condition. However, previous studies suggest an association between urogynecological infections and vulvodynia. Given that personal hygienic behaviors, such as wearing tight fitting jeans or pants, and performing vaginal douching, increase the risk of gynecologic infections, we sought to determine whether these practices impact the risk of vulvodynia.

We studied approximately 200 women with and 200 women without clinically confirmed vulvodynia.

Who Teaches Faculty to Educate Medical Residents About Opioids for Chronic Pain?

PainRelief.com Interview with:

Payel Roy, MD
Section of General Internal Medicine
Department of Medicine
Boston University School of Medicine and Boston Medical Center
Boston, Massachusetts.

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

Response: Given the current opioid crisis, we know how important it is to educate physicians-in-training in safer opioid prescribing.  But we can’t educate them properly if their faculty mentors don’t feel comfortable prescribing opioids themselves.  Our study evaluated a program designed to improve faculty physicians’ comfort in prescribing opioids safely and teaching these practices to trainee physicians.  

We found that faculty development programs can improve their confidence in prescribing opioids safely and teaching their trainees about prescribing, however translating these attitudes into teaching practice remains a challenge.

Migraine Linked to Poor Sleep and Sleep Apnea

PainRelief.com Interview with:

Dawn C. Buse PhD
 Clinical Professor of Neurology
 Albert Einstein College of Medicine
 New York City

Dawn C. Buse PhD
Clinical Professor of Neurology
Albert Einstein College of Medicine
New York City

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

Response: Sleep is essential in the regulation of a wide range of homeostatic functions.  Dysregulation of sleep process may be triggers for migraine attacks and increase the risk of migraine disease chronification.  Migraine is comorbid with a range of medical, neurologic, and psychiatric comorbidities that may exacerbate the disease, complicate treatment, and reduce health-related quality of life.  These comorbidities include sleep disorders such as sleep apnea, insomnia, circadian rhythm (i.e., sleep-wake) disorders, and sleep movement disorders.

The Chronic Migraine Epidemiology and Outcomes (CaMEO) Study is a longitudinal study that used a series of web-based surveys over 15 months to assess migraine symptoms, burden and patterns of healthcare utilization among people in the US population.  Validated questionnaires were used to assess many comorbidities.  Migraine can be classified based on the number of headache days per month into episodic migraine (<15 headache days/month) and chronic migraine (≥15 headache days/month).

In this cross-sectional analysis of data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study, we assessed sleep apnea and poor sleep quality in a US population based sample of 12,810 people with migraine.  Respondents were stratified by episodic (11,699) and chronic (1,111) migraine and by body mass index (BMI).

Chronic Pain the Most Common Reason People Use Medical Cannabis

PainRelief.com Interview with:

cannabis wikipedia image

Kevin Boehnke, Ph.D. Research investigator
Department of Anesthesiology and the Chronic Pain and Fatigue Research Center
University of Michigan

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

Response: Medical cannabis is legal in 33 states, and people can obtain medical cannabis licenses to treat a wide swath of conditions, including cancer, anxiety, irritable bowel syndrome, chronic pain, complications of Alzheimer’s disease, and nausea. Many observational surveys have found that many people use cannabis for chronic pain, but whether these surveys were representative of national trends was uncertain. To our knowledge, this was the first study that examined nationwide trends of patient-reported qualifying conditions based on medical cannabis state registries.

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Study Shows Difficulty of Modifying Course of Chronic Pain

PainRelief.com Interview with:

Dr. Enric Aragonès, MD PhD
Family Physician. Catalan Health Institute and IDIAP Jordi Gol
Barcelona

Dr. Enric Aragonès, MD PhD
Family Physician. Catalan Health Institute and
IDIAP Jordi Gol
Barcelona

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

Response: Our team follows a line of research in the development, evaluation and implementation of new models of collaborative care to improve the management and outcomes of depression in primary care in Spain. Taking into account the close epidemiological, physiopathological and clinical relationships between depression and chronic pain, we designed a multicomponent care model at the integrated management of this comorbidity: the DROP (DepRession and Pain) program.

In the present RCT, our results show some effect in the improvement of depressive symptoms but, contrary to hypothesis, we have not demonstrated its efficacy in the evolution of chronic pain.

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Knee Osteoarthritis: NSAIDS Offer Short-Term Pain Relief

PainRelief.com Interview with:

Raveendhara R. Bannuru MD, PhD, FAGE

Raveendhara R. Bannuru MD, PhD, FAGE
Director, Center for Treatment Comparison and Integrative Analysis (CTCIA)
Deputy Director, Center for Complementary and Integrative Medicine (CCIM)
Asst Professor of Medicine, Tufts University School of Medicine
Asst Professor of Clinical & Translational Science
Sackler School of Graduate Biomedical Sciences
Division of Rheumatology, Tufts Medical Center
Boston, MA

Director, Center for Treatment Comparison and Integrative Analysis (CTCIA)
Deputy Director, Center for Complementary and Integrative Medicine (CCIM)
Asst Professor of Medicine, Tufts University School of Medicine
Asst Professor of Clinical & Translational Science
Sackler School of Graduate Biomedical Sciences
Division of Rheumatology, Tufts Medical Center
Boston, MA

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

Response: Though the higher rates of certain adverse events due to NSAIDs are well documented, we were curious about how soon these adverse events can begin to manifest. We were similarly interested in the efficacy trajectories of NSAIDs, because previous studies had conducted analyses of the last reported follow-up times for the drugs, but we noticed that many of the studies had only very short-term follow up ranging between 1-4 weeks which didn’t provide a more complete picture of the therapeutic effect over time.

The key findings of our study are that the widely used NSAIDs are very effective for short-term pain relief but their efficacy wanes over a period of 12 weeks. The adverse events though mild in nature start appearing within 4 weeks of treatment.

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Palliative Care at Home Linked To Greater Pain Relief, Regardless of Illness

PainRelief.com Interview with:

Dr Yousuf El Mokhallalati  MD, MPH and PhD candidate
Research Assistant, and PhD candidate
Academic Unit of Palliative Care
Leeds Institute of Health Sciences (LIHS)
University of Leeds
Leeds, UK

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

Response: We examined the factors associated with good pain relief at before death, using data which was drawn from responses to the National Bereavement Survey (VOICES) in England between 2011 and 2015, which asked families or close relatives to reflect on the quality of care provided to a person who had died.

Just 10% of patients who died of a non-cancerous disease received palliative care at home, compared to 63% of cancer patients.

 The study revealed that people who accessed palliative care at home were 2.7 times more likely to have experienced good pain relief compared to those who did not receive palliative care.

The association between good pain relief and palliative care at home occurred regardless of the type of disease that patients had, but access to palliative care was not provided equally.

This research shows that palliative care is associated with significant benefits to people with every kind of progressive disease, but this is not reflected in the spread of people that are being offered palliative care.

The study also suggests that patients who had planned where they wanted to die are nearly twice as likely to experience good pain relief compared to those who had not, showing the value of planning ahead and coordinating the support of healthcare professionals.

Only a quarter of patients were found to have recorded a preferred place of death. Cancer patients were nearly three times more likely to have a preference recorded compared to non-cancer patients (36.6% of cancer patients versus 13.1% of non-cancer patients).

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