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.

Continue reading

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.

Continue reading

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).

Continue reading

New IR Treatment for ‘Tennis Elbow’ Offers Pain Relief Without Surgery

PainRelief.com Interview with:
Yuji Okuno, MD, PhD
Founder of the Okuno Clinic
Japan 

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

Response: Tennis elbow, also known as lateral epicondylitis, is a painful condition that affects nearly 3 percent of U.S. adults and can result in chronic pain.

It stems from repetitive stress injuries to the tendons and muscles around the elbow that occur from common activities such as cooking, sports, and childcare. Many people end up going through invasive surgery to try and treat the pain, but it doesn’t always help.

We wanted to test a current method used in cancer treatments, known as transcatheter arterial embolization (TAE), to see if it could be effective in treating the pain that stems from lateral epicondylitis.

Our team conducted a prospective study in 52 patients with tennis elbow who did not find relief from other forms of treatment. The patients received TAE between March 2013 and October 2016 and were followed for up to four years after the treatment.

Continue reading

Low Carbohydrate Diet May Reduce Pain from Knee Osteoarthritis

PainRelief.com Interview with:
Robert E. Sorge, PhD | Associate Professor
College of Arts and Sciences
Department of Psychology
Director | PAIN Collective
UAB | The University of Alabama at Birmingham

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

Response: Our work in animals has shown that a poor-quality diet (high in refined carbohydrates) leads to widespread inflammation, activated immune cells and prolongs recovery from an injury. We have also shown that diet can reverse these effects. Therefore, we wanted to see whether we could reduce pain in people with knee osteroarthritis just by changing their diet.

We know that carbohydrates can lead to inflammation and oxidative stress, so we wanted to know whether reducing them would reduce pain or whether pain could be reduced by just losing weight – the knee is a weight-bearing joint, after all. We found that weight loss did not predict pain relief, but that the participants following a low-carb diet showed reduced daily pain, reported less pain interference in daily activities and had less pain when we evoked pain in their knees. The reduction in evoked pain was related to changes in oxidative stress.

Ours is a small study, but we believe that it is important to let people know that a change of diet can have a significant impact on their daily pain. Diets are modifiable and have no negative side effects – something not true of most pain-relieving medications.

Continue reading

Who Prescribes More Opioids for Pain Relief? Physicians or Physician Extenders?

Photo of Dr. Michael Issac Ellenbogen, M.D.

Michael Ellenbogen, MD
Assistant Professor of Internal Medicine
Johns Hopkins School of Medicine 

What is the background for this study? What are the main findings?

Nurse practitioners (NPs) and physician assistants (PAs) are becoming an increasingly important and larger part of the healthcare workforce, especially in general internal medicine. To our knowledge, differences in opioid prescribing among generalist physicians, NPs, and PAs have not been evaluated. We aimed to learn if there are differences in opioid prescribing among generalist physicians, NPs, and PAs to Medicare beneficiaries.     

We performed a serial cross-sectional analysis of prescription claims from 2013 to 2016 using publicly available data from the Centers for Medicare and Medicaid Services. All generalist physicians, NPs, and PAs who provided more than ten total prescription claims between 2013 and 2016 were included. These prescribers were subsetted as practicing in a primary care, urgent care, or hospital-based setting.

We found that the overall volume and proportion of opioid prescribing is heavily right-skewed. The mean opioid prescription proportions (as a proportion of all prescription claims) for physicians in primary care, urgent care/walk-in clinics, and hospital medicine were 4.69, 6.72, and 6.66 relative to 7.10, 11.97, and 11.01 for PAs.  The adjusted total opioid claims across these four years for physicians was 660 (95% confidence interval: 660-661), for NPs was 755 

(95% CI: 753-757), and for PAs was 812 (95% CI: 811-814). 

What should readers take away from your report?

Continue reading

Nordic Countries Also See Rapid Increase in Opioid Prescriptions for Pain Relief

PainRelief.com Interview with:
Ley (Ashley) Muller, PhD
University of Oslo

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

Response: The North American opioid crisis is clearly linked to the high availability of prescription opioids. In the Nordic countries of Denmark, Sweden, and Norway, the pharmaceutical industry is much more regulated, including bans on marketing to physicians, so the market isn’t flush with opioids. However, these countries have ageing populations with some of the highest rates of chronic non-cancer pain in the world, and over-prescription for this type of pain was one of the triggers of the North American crisis. 

This begs the question: how sure are we that strong pharmaceutical regulations alone can protect countries from prescription opioid problems?  

Continue reading

Many Patients Prescribed Medical Marijuana for Pain Relief, Use the Cannabis for Recreational Use

PainRelief.com Interview with:
Meghan Rabbitt Morean, Ph.D.

Assistant Professor of Psychology
Oberlin College
Adjunct Assistant Professor of Psychiatry
Department of Psychiatry 
Yale School of Medicine
New Haven, CT 04519

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

Response: Currently, medical marijuana is legal in 33 states and the District of Columbia and recreational marijuana is legal in 10 states and the District of Columbia (although it remains a Schedule I drug at the federal level).

Chronic pain is an approved condition for medical marijuana in all states in which medical marijuana is legal. However, there is concern that a sizeable percentage of medical marijuana patients also are using their medicine recreationally.

In the current study, we found that more than half (55.5%) of medical marijuana patients also reported using their medical marijuana for recreational purposes, which is similar to rates observed in a previous study.  

Continue reading

National Trends in Prescription Opioid Risk Reduction Practices

PainRelief.com Interview with:
Daniel P. Alford, MD, MPH
Professor of Medicine
Associate Dean, Continuing Medical Education
Director, Clinical Addiction Research and Education (CARE) Unit
Director, Safe and Competent Opioid Prescribing Education (SCOPE of Pain) Program
Boston University School of Medicine
Boston Medical Center, Boston MA 02118

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

Response: Boston University School of Medicine’s Safe and Competent Opioid Prescribing Education (SCOPE of Pain) is the longest-running safer opioid prescribing educational program under the FDA’s opioid Risk Evaluation and Mitigation Strategy (REMS). 

This study analyzed clinicians’, who were registering to attend a SCOPE of Pain training, self-report of performing five opioid prescribing risk-mitigation practices with patients prescribed opioids for chronic pain including:

  1. Use of patient-prescriber agreements,

2) Informing patients about taking opioids exactly as prescribed,

3) Discussing safe opioid storage and disposal,

4) Discussing risks of opioid-associated respiratory depression and overdose, and

5) Monitoring for misuse including urine drug test and/or pill counts, prior to participating in the training.

Continue reading

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.
Continue reading