Mindfulness-Based Stress Reduction & Cognitive Behavioral Therapy for Chronic Pain Relief

PainRelief.com Interview with:
Eve Ling-Khoo,MSc. OT Candidate, BSc. Hons
Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

"Cognitive Therapy | Fox Valley Institute, Naperville IL (630) 718-0717" by Fox valley Institute is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0

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

  • 20% of adults worldwide suffer from chronic pain which impacts all facets of well-being.
  • Cognitive behavioral therapy (CBT) is the current gold standard for psychological intervention, but not everyone responds to it.
  • Mindfulness-based stress reduction (MBSR) is an alternative with the potential to improve the quality of life of patients with chronic pain.
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Variety of Pain Relief Medications Reduced Opioid Usage in Trauma Patients

PainRelief.com Interview with:
Christine S. Cocanour, M.D., F.A.C.S., F.C.C.M.
Division of Trauma, Acute Care Surgery and Surgical Critical Care 
UC Davis Health

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

Response: Our critical care pharmacists (Duby, Hamrick and Lee) and surgeons (Cocanour, Beyer) wanted to decrease our use of opioids without compromising pain control in our trauma patients—especially those that were admitted to the ICU.  To help make more appropriate choices we put together an order set that was a multimodal approach to pain management. 

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Hypnosis for Pain Relief

PainRelief.com Interview with:

Dr Trevor Thompson BSc Hons, MSc, PhD

Dr Trevor Thompson BSc Hons, MSc, PhD

Senior Lecturer, Faculty of Education and Health
University of Greenwich
London,United Kingdom

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

Response: Pretty much everyone now is aware of the opioid ‘crisis’. Opioid medications can offer highly effective pain relief for some, but also have addictive properties, side effects and provide unsatisfactory pain relief for many others. The Center for Disease Control and Prevention suggest that an estimated two million individuals in the US alone are addicted to prescription opioid analgesics, and this has been linked to over 17,000 overdose deaths and over $78 billion annual costs.

All of this has acted as a catalyst for renewed interest in non-pharmacological interventions for pain. Hypnosis is one such intervention and can be administered by a trained hypnotherapist or even as a simple 20-minute audio recording (usually in the form of relaxing imagery accompanied by suggestions of pain relief, e.g. ‘imagine being completely filled with sensation of relief’). The degree to which hypnosis is effective for reducing pain, however, is not entirely clear and exaggerated claims for its efficacy have generally created scepticism.  Clinical studies suggest hypnosis may be effective, but these data suffer from a number of limitations. We therefore analysed pooled data from controlled experimental studies that have used laboratory-induced pain (e.g. cold, heat, pressure etc), which can avoid some of the shortcomings of clinical data.

Meta-analysis of 85 studies consisting of 3632 participants supported the effectiveness of hypnosis and found that efficacy was strongly dependent upon hypnotic suggestibility. Compared to control conditions, pain ratings for hypnosis were 42% (p<.001) lower for individuals high in suggestibility and 29% (p<.001) lower for those with medium suggestibility.

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Neck and Back Pain More Common in Diabetes

PainRelief.com Interview with:

Manuela L. Ferreira PhD
Institute of Bone and Joint Research
The Kolling Institute, Sydney Medical School

Paulo H. Ferreira PhD
Musculoskeletal Health Research Group
Faculty of Health Sciences
University of Sydney, Sydney, NSW, Australia

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

Response: One in four Australians experience back pain or neck pain. Diabetes is also a worldwide prevalent condition, and currently affects over 382 million people. These two diseases often co-exist and have very similar underlying mechanisms, such as obesity and physical inactivity. We were unsure whether having one condition would lead to developing the other, however.

We have found 11 studies published to date, and assessing the relation between back or neck pain and diabetes. The studies included over 165,000 participants published in the USA, Canada, Finland, Denmark, Iran and Spain.

When we pooled the results of these studies together, we observed that people with type 2 diabetes are 35% more likely to also have low back pain (compared to people without diabetes). The risk of having severe back pain symptoms in people with type 2 diabetes is 63% higher and the risk of having severe neck pain is almost 30% higher, than in people with no diabetes.  We could not identify, however, whether type 2 diabetes can lead to back or neck pain, and it is possible that the two conditions are associated via other underlying mechanisms such as obesity and physical inactivity.

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Opioid-Induced Constipation

Chronic Pain Patients: Opioid Induced Constipation a Serious Concern After Surgery

PainRelief.com Interview with:

Jonathan Jahr, MD, DABA, FASA

Dr. Jonathan Jahr is an anesthesiologist in Los Angeles, California and is affiliated with multiple hospitals in the area, including UCLA Medical Center and UCLA Medical Center-Santa Monica. He received his medical degree from New York Medical College and has been in practice for more than 20 years.

Dr-Jonathan-Jahr

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

Response: I have worked in the hospital setting for the past 25 years and have conducted multiple studies on different opioid and non-opioid strategies for managing both chronic and acute pain. I also co-edited a textbook entitled Essence of Analgesia and Analgesics. My background and the research I’ve done sets the stage for newer pain management protocols that can provide patients with significant pain relief, and improved satisfaction and outcomes due to fewer or avoided opioid related side effects (ORADS) such as opioid-induced constipation (OIC).

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EXPAREL TAP Block Provides Pain Relief For Cesarean Delivery With Less Opioids

PainRelief.com Interview with:

B. Wycke Baker, MD
Chief of Service, Anesthesiology at Texas Children’s Pavilion for Women
Clinical Professor of Anesthesiology, Obstetrics and Gynecology
Baylor College of Medicine 

pacira pharmaceuticals

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

Response: For this study, we reviewed the charts of 201 women who underwent cesarean deliveries and received a multimodal pain management protocol with or without a TAP block utilizing EXPAREL, a long-acting, non-opioid option to manage pain following surgery. A TAP block, or a transversus abdominis plane block, is a field block that numbs the nerves that supply the abdominal wall. The study included patients who underwent elective, unscheduled waiting list, or emergency cesarean delivery with combined spinal-epidural anesthesia and post-cesarean pain management at Texas Children’s Hospital Pavilion for Women between 2012 and 2015.

The findings revealed many positive outcomes for patients who received a TAP block utilizing EXPAREL compared to those who received multimodal pain control without a TAP block utilizing EXPAREL. For instance, patients who received EXPAREL TAP block showed a significant decrease in postsurgical pain as well as a significant decrease in opioid consumption. On average, patients who received EXPAREL TAP block had shorter time to discharge from PACU, shorter time to readiness for discharge to home, and shorter length of stay in hospital than those who did not receive EXPAREL TAP block.

Further, a significantly higher number of patients treated with EXPAREL TAP block (12%) compared to those without EXPAREL TAP block (3%) consumed no opioids after surgery. Fewer patients treated with EXPAREL TAP block (34%) compared to those without EXPAREL TAP block (50%) reported any adverse events following the delivery.

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Online Patient Materials Unlikely to Discuss Risk of Opioids Prescribed for Pain Relief

PainRelief.com Interview with:

Edward R. Mariano, MD, MAS (Clinical Research)
Chief, Anesthesiology and Perioperative Care Service and
Associate Chief of Staff for Inpatient Surgical Services
VA Palo Alto Health Care System
Professor of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Palo Alto, CA  94304

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

Response: Today, there is so much attention on the opioid epidemic, and patients and clinicians are constantly reminded about the dangers of opioids. Guidelines have recommended the provision of patient and caregiver education on pain management, especially on how to taper (safely decrease and eventually stop taking) opioids after surgery. With over 70 fellowship programs in regional anesthesiology and acute pain medicine, we assumed that there would be plenty of information for patients on safe opioid management online since most people use the internet to find health-related information. We conducted a rigorous search for online patient education materials related to safe opioid management, evaluated to reading level and content, and compared materials produced by fellowship programs to other online educational materials. Unfortunately, the average reading level for all materials we found was above the level recommended for patients (sixth grade or lower). Most fellowship programs in regional anesthesiology and acute pain medicine did not even offer online patient education materials and were less likely to describe overdose risk and opioid disposal. Less than half of all materials mentioned tapering or cessation of opioids after surgery (see visual abstract attached).

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Pain and Substance Use Can Interact in a Vicious Cycle

PainRelief.com Interview with:

Emily L. Zale PhD Department of Psychology Syracuse University Syracuse, New York

Dr. Zale

Emily L. Zale PhD
Department of Psychology
Syracuse University
Syracuse, New York

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

Response: When people think of pain and substance use, it’s common for opioids to come to mind. While the opioid crisis has rightfully garnered considerable attention, our research suggests that non-opioid substances, like nicotine/tobacco, alcohol, and cannabis, are also important to consider in relation to pain. In fact, nicotine/tobacco, alcohol, and cannabis are the most commonly used substances in the US, and research into associations between pain and these non-opioid substances is continuing to increase in popularity.

Research studies usually examine either how substance use affects pain or how pain affects substance use. We looked at results from over 100 studies and put these two different types of research together to understand how pain and substance use affect each other.

On one hand, substance use can be a risk factor for chronic pain and may worsen pain over time. On the other hand, experiencing pain can motivate people to use substances and might make it harder to quit. By putting these two types of studies together, we found that pain and substance use  interact in a vicious cycle that can ultimately worsen and maintain both chronic pain and addiction.

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Gabapentin For Pain Relief of Vulvodynia

MedicalResearch.com Interview with:
Gloria A Bachmann, MD
Professor of Obstetrics and Gynecology and Medicine
Associate Dean for Women’s Health
Director, Women’s Health Institute
Rutgers Robert Wood Johnson Medical School

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

Response: Chronic pain is an extremely difficult symptom for anyone to deal with, regardless of the cause. However, when the pain involves the genital area, it exacerbates the pain condition, as it then becomes a more sensitive area for the person to talk about and to feel comfortable in asking for medical help. This is precisely the case for women with vulvodynia.

Vulvodynia is defined as a pain that persists over several months in the outer area of the vaginal opening. Symptoms women often have from this condition, in addition to the pain itself, include burning, pressure, itching and soreness. Some women note the pain in the entire area surrounding the vaginal opening, whereas others only note it in one or two sites. Further, for many women the pain interferes with their ability to engage in sexual exchange, the wearing of certain types of clothing and even the ability to start a family as coital activity may not be possible for them. Unfortunately, because the exact cause of vulvodynia has not been described, treatments are varied and aim at treating the pain rather than the underlying cause. One intervention that has been used for women with this condition is the medication, gabapentin. However, although it appears to be a successful intervention for some sufferers, there had not been a definitive clinical trial that looked at this medication as it compares to a placebo intervention.

Therefore, our Rutgers site, along with the University of Tennessee and the University of Rochester commenced a clinical trial to test how effective gabapentin was as compared to a placebo, or non-pharmacologic intervention in women with this condition. Continue reading

Study Suggest Opioids Should Not Be First Line Therapy for Chronic Non-Cancer Pain

PainRelief.com Interview with:

Dr. Jason Busse PhD Associate Professor McMaster University

Dr. Busse


Dr. Jason Busse PhD
Associate Professor
McMaster University

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

Response: The United States prescribes more opioids per capita than any other country in the world, and opioids are associated with addiction, overdose, and death. Many individuals living with chronic noncancer pain are managed with opioid therapy; however, we have limited knowledge regarding benefits and harms. We conducted a systematic review and meta-analysis to synthesize the evidence from all RCTs that explored an opioid vs. a non-opioid comparator for patients with chronic noncancer pain, and followed participants for at least 1 month. Continue reading