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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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.

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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.  

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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.

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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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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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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

Massage for Osteoarthritis of Knee Reduced Pain and Improved Physical Functioning

Adam-Perlman-

Dr. Perlman

PainRelief.com Interview with:
Adam Perlman, MD, MPH

Program Director, Leadership Program in Integrative Healthcare
Duke Integrative Medicine 

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

Response: Current treatment options for knee osteoarthritis have limited effectiveness and potentially adverse side effects. Massage may offer a safe and effective complement to the management of knee osteoarthritis.

We investigated the effect of whole-body massage on knee osteoarthritis, compared to active control (light-touch), and usual care. Participants received 8 weeks of massage, light-touch or usual care and then were randomly assigned to maintenance every other week massage, light-touch or continuation of their usual care. At the end of 8 weeks, massage significantly improved symptoms, including pain, stiffness and physical function, while the other groups did not. At 52 weeks, every other week massage maintained the improvements, however the other groups also improved. Continue reading