PainRelief.com Interview with: Amani Meaidi, Postdoc, MD, Ph.D. Danish Cancer Society Danish Cancer Society Research Center Copenhagen
PainRelief.com: What is the background for this study?
Response:Use of birth control formulations containing estrogen (combined hormonal contraception) is an acknowledged risk factor for venous thromboembolism.
NSAID use has also been shown to increase risk of thrombosis
NSAID use is likely to be the most common co-medication to hormonal contraception use – still, no study has looked at the effect of concomitant use of hormonal contraception and NSAID on venous thromboembolic risk.
Thus, we decided to study the thrombosis safety of using hormonal contraception and NSAIDs simultaneously.
PainRelief.com Interview with: Dr Anders Holt Department of Cardiology Copenhagen University Hospital–Herlev and Gentofte Hellerup, Denmark
PainRelief.com: What is the background for this study?
Response: Type 2 diabetes mellitus has been related to cardiomyopathy and subclinical heart failure, as well as compromised kidney function. Likewise, nonsteroidal anti-inflammatory drugs (NSAIDs) can cause fluid retention and have been previously linked to heart disease. Thus, use of NSAIDs in patients with T2DM could be expected to increase risk of heart failure (HF), possibly by worsening already prevalent subclinical HF or by aberrating fluid balances. Specific recommendations for short-term use in patients with T2DM, along with exploration of proposed mechanisms, are scarce, especially considering that NSAIDs are among the most used prescription and over-the-counter drugs worldwide.
PainRelief.com Interview with: Filippo Migliorini MD, PhD, MBA Department of Orthopedic, Trauma, and Reconstructive Surgery RWTH University Hospital of Aachen
Dr. Migliorini
PainRelief.com: What is the background for this study?
Response: Acute low back pain imposes a significant socioeconomic burden worldwide. The pharmacological management of acute low back pain aims to restore daily activities and improve the quality of life. No magic bullet exists: interventions to reduce pain and disability are available, but long-term results are unpredictable. This is often hard to accept for clinicians and patients and provides fertile soil to quacks, faith healers, and gurus to promote miraculous non-evidence-based solutions. Education in this regard needs to improve.
Acute low back pain management is not well codified and extremely heterogeneous, and residual symptoms are common. Depending on the individual severity, pharmacological management may range from nonopioid to opioid analgesics. The literature regarding the best non-opioid pharmacological management of acute low back pain is limited, and the indications available in the literature are conflicting. Our investigation aimed to systematically review the level I evidence on the administration of myorelaxants, nonsteroidal anti-inflammatory drugs, and paracetamol in patients with low back pain.
PainRelief.com Interview with: Beth Wallace, M.D. M.Sc Associate Investigator, Center for Clinical Management Research Staff Physician, Rheumatology VA Ann Arbor Healthcare System Assistant Professor, Division of Rheumatology University of Michigan
Dr. Wallace
PainRelief.com: What is the background for this study?
Response: Arthritis and joint pain are common among older adults. We used data from the University of Michigan National Poll on Healthy Aging to understand how a national sample of older adults experiences and manages joint pain.
PainRelief.com: What are the main findings?
Response: Seventy percent of adults aged 50-80 report that they have joint pain. Three in five have a diagnosis of arthritis, including 30% who have a diagnosis of osteoarthritis (also called “wear and tear” or “bone on bone” arthritis).
Of those with joint pain, half said that it limited their usual activities, but about three in four said that they saw arthritis and joint pain as a normal part of aging that they could manage on their own.
More than half of all adults use over-the-counter pain relievers like non-steroidal anti-inflammatory drugs (Advil, Motrin, Aleve) for joint pain. One in ten used a prescription oral steroid, like prednisone. This is important because these medications can cause or worsen health conditions common in older people, such as high blood pressure and heart disease. More than a quarter of adults who used oral steroids for joint pain did not remember discussing the risks of these medications with their health care provider.
Ninety percent of those with joint pain used non-medication treatments, like exercise, massage, and splints and braces, to manage their symptoms. Most people who used these treatments found them to be very helpful.
Jason E. Goldstick, PhD Injury Prevention Center Department of Emergency Medicine University of Michigan, Ann Arbor
PainRelief.com: What is the background for this study? What are the main findings?
Response: In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. A primary goal of this voluntary guideline is that individuals should receive pain management care that provides the greatest overall benefit. Among other things, this may entail beginning opioid treatment only when the clinician determines that the expected benefits outweigh the risks.
Other research has shown reductions in opioid prescribing as reduced since the guideline release; this report examines whether there were changes in nonopioid pain medication prescribing.
Our overall findings were that nonopioid prescribing increased nationally following the guideline release, above and beyond what would’ve been predicted based on the pre-guideline trends, and this finding was generally consistent across patient subpopulations (e.g., those with vs. without prior opioid exposure).
PainRelief.com Interview with: Dan P. Ly M.D., M.P.P., Ph.D. Division of General Internal Medicine and Health Services Research David Geffen School of Medicine University of California, Los Angeles
PainRelief.com: What is the background for this study? What are the main findings?
Response: We know that minority patients were less likely to receive opioids than white patients, but this could have been due to minority patients seeing lower opioid-prescribing physicians. As far as I could tell, nobody had been able to examine whether the same physician prescribed opioids differently to their minority patients.
I find that this is the case: the same physician was less likely to prescribe opioids to their minority patients with new low back pain, and instead was more likely to prescribe NSAIDs to their minority patients. And unfortunately, this differential prescribing may have had the consequence of leading to more chronic opioid use in white patients.
PainRelief.com Interview with: Benjamin W. Friedman, MD, MS, FAAEM, FACEP, FAHS Professor of Emergency Medicine Vice-chair for Clinical Investigation Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx, NY 10467
PainRelief.com: What is the background for this study? What are the main findings?
Response:A very large number of patients present to US EDs annually with back pain. No medications have proven more effective than NSAIDs for low back pain. Similarly, combining other medications such as skeletal muscle relaxants or opioids with NSAIDs does not improve outcomes more than NSAIDs alone.
Prior to our study, little was known about which NSAIDs were most efficacious for acute low back pain.
The main finding of our study is that ketorolac was more efficacious than ibuprofen for some two and five day outcomes that are important for patients.
Mary K. Mulcahey, MD, FAAOS, FAOA Director, Women’s Sports Medicine Program Associate Professor Assistant Program Director Department of Orthopaedic Surgery Tulane University School of Medicine New Orleans, LA
PainRelief.com: What is the background for this study? What are the main findings?
Response: Osteoarthritis Research Society (OARSI) guidelines include topical non-steroidal anti-inflammatory drugs (NSAIDs) as a level 1A recommendation for non-operative management of knee osteoarthritis, but previous reviews have demonstrated that clinical adoption of this treatment option lags. We conducted a systematic review and meta-analysis of 18 studies evaluating diclofenac, ketoprofen, and ibuprofen in topical preparations. We found that they are safe and effective for reducing pain and improving physical function in patients with knee osteoarthritis. Diclofenac had the strongest quality and number of studies and showed a moderate effect size for symptomatic improvement. With regards to safety, adverse events were low in the topical treatment groups, and topical preparations containing dimethyl sulfoxide (DMSO) showed a higher odds ratio for adverse events than preparations without DMSO.
PainRelief.com Interview with: Dr. Perez Cajaraville MD EDPM Clinical Director Pain Unit HM Hospitales Madrid. Spain
Dr. Cajaraville
PainRelief.com: What is the background for this study?
Response: The addition of L-arginine to the molecule of ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), in the salt form of ibuprofen arginate has the rationale to enhance the absorption rate of the active S-(+) enantiomer of ibuprofen to achieve a rapid onset analgesic action. Despite availability of ibuprofen arginate in the market for many years, a comprehensive review of the evidence of the analgesic efficacy, tolerability and safety in different pain models has not been previously reported.
PainRelief.com Interview with: Dr Thomas Perry PhD| Postdoctoral Research Fellow Versus Arthritis Centre for Sport, Exercise and Osteoarthritis Research Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences
Dr. Perry
PainRelief.com: What is the background for this study?
Response: Management of knee osteoarthritis (OA) is multi-factorial and routinely involves the use pharmacological interventions; with most medications aimed at alleviating painful symptoms and improving function.
Little is known of the long-term effects of such medications on the structural progression of radiographic knee OA. Through examining the relationship between pharmacological interventions and the disease pathway, this may, in turn, identify potential areas for disease-modifying treatment development.
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