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

Early Physical Therapy Can Be Protective Against Chronic Opioid Use

PainRelief.com Interview with:

Steven Z. George, PT, PhD  Professor Director of Musculoskeletal Research Duke Clinical Research Institute Vice Chair of Clinical Research Orthopaedic Surgery

Dr. George

Steven Z. George, PT, PhD 
Professor
Director of Musculoskeletal Research
Duke Clinical Research Institute
Vice Chair of Clinical Research
Orthopaedic Surgery

PainRelief.com: What is the background for this study? What are the main findings?Response: This study adds to existing health services research investigating the sequence of services/providers for musculoskeletal pain and its impact on opioid use.

The study suggest that early physical therapy (PT) for the 4 most common musculoskeletal conditions (back, neck, shoulder, and knee) can be protective of chronic/long term opioid use for individuals that were opioid naïve when presenting for their care.  What is different about this study is that the 4 conditions were studied in the same cohort and the same definition of early PT was used (many of the previous studies just looked at 1 conditions, and used different definitions of early physical therapy).  The other thing that was different is that we used a larger dataset of private insurance providers, so this study cuts across different regions of the study (many of the previous studies included one health system).

There was notable consistency in the findings for the 4 conditions and protection of any opioid use, but there were some contingencies.

First was that there was no benefit on decreased dosage for individuals with neck pain – as that was not expected.

Second was that in a follow up sensitivity analysis it looked like the largest benefit of early physical therapy may be for those with back and knee pain.  Continue reading

Acupuncture Provided Pain Relief From Cancer and Related Symptoms

PainRelief.com Interview with:
Jai N. Patel, PharmD, BCOP
Chief, Pharmacology Research
Associate Professor, Division of Hematology/Oncology
Department of Cancer Pharmacology
Levine Cancer Institute
Charlotte, NC 28204 

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

Response: Pain is one of the most prevalent and burdensome symptoms affecting patients with cancer. Cancer-related pain is most commonly treated with opioid analgesics; however, nearly two-thirds of patients have inadequate pain relief and/or experience opioid-related side effects.

Furthermore, the fear of opioid abuse/addiction and toxicity deters some from prescribing opioids and reduces patient compliance. Thus, nonpharmacologic interventions such as acupuncture may be safer approaches to cancer-related pain.  Randomized controlled trials suggest acupuncture reduces chronic neuropathic and postoperative pain in patients with cancer. It is unknown whether any patient characteristics predict post-acupuncture pain response.

We assessed acupuncture’s effectiveness for cancer-related pain, identified patient characteristics associated with pain response, and determined its effect on other concurrent cancer-related symptoms in palliative medicine outpatients. We identified significant benefits in pain scores immediately after the first treatment and across multiple treatments. Significant pain reduction was associated with higher baseline pain and more advanced disease stage.

We also identified significant changes in anxiety, depression, drowsiness, dyspnea, fatigue, nausea and well-being. Improvements in fatigue and depression also correlated with significant pain reduction after acupuncture.  Continue reading

SEAL Procedure Gives Pain Relief To Some After Failed Back Surgery

MedicalResearch.com Interview with:
"Personal Injury Back Pain" by SanDiego PersonalInjuryAttorney is licensed under CC BY-SA 2.0
Michael Perloff, MD PhD

Assistant Professor of Neurology
Interventional Pain Management
Boston University School of Medicine

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

Response: Low back pain is very common. Patients with chronic low back pain that does not benefit from physical therapy, medications, or injections, often get spine surgery. If surgery fails to help (Failed back surgery syndrome-i.e. continued low back and leg pain after surgery), options for pain relief become more complex.

Typically, patients with failed low back surgery syndrome have tried complex procedures, repeat surgery or technology implants as their main options.

The SEAL procedure is a shortened, simple procedure (done in about 20 minutes) that can help as treatment for failed back surgery symptoms. In the published case series of 30 patients, some patients achieved very good, sustained, pain relief. Continue reading

FDA Approved Emgality Offers New Hope For Migraine Prevention

PainRelief.com Interview with:
Gudarz Davar, M.D., Vice President
Neuroscience Platform Leader
Eli Lilly and Company

PainRelief.com: What is the background for this announcement?  How big a problem is migraine in the US?  Who is primarily affected? 

Response: Migraine is a disabling, neurologic disease that affects more than 30 million American adults. According to the Medical Expenditures Panel Survey, the total unadjusted cost associated with migraine in the U.S. is estimated to be as high as $56 billion annually. People with migraine can miss out on significant moments in their lives—birthdays and anniversaries—and there remains an unmet need for treatment options that can help patients achieve significant reductions in the overall frequency of migraine attacks.

Emgality (galcanezumab-gnlm) was approved by the FDA on Thursday, September 27, for the preventive treatment of migraine in adults. Emgality is a humanized monoclonal antibody indicated for the preventive treatment of migraine in adults that binds to CGRP ligand and blocks its binding to the receptor, which is believed to play a role in migraine. It is offered as a self-administered, once-monthly subcutaneous injection. Emgality offers new hope to people living with migraine as one of the first medicines developed specifically for the prevention of migraine.

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Exercise Longer With Less Pain Using Virtual Reality

PainRelief.com Interview with:

This is a visual of VR exercise environment during test.

This is a visual of VR exercise environment during test.
Credit Maria Matsangidou

Maria Matsangidou, PhD
School of Engineering and Digital Arts
University of Kent

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

Response: The results show that Virtual Reality (VR) technology can influence the perception of task difficulty, endurance performance and pain experienced during exercise. Most importantly, exercising through the use of VR technology revealed a significant decrease in Pain Intensity and Perceived Exertion reports, and a significant increase in Time to Exhaustion. This was contrary to conventional non-VR exercise which was found to have a significantly higher Pain Intensity and Perceived Exertion reports, and a significantly lower Time to Exhaustion.

In addition the results show that personal characteristics of internal body awareness, such as Private Body Consciousness, does not influence the efficiency VR has on the time to and the perceived pain and exhaustion. This means that the effectiveness of VR technology on time and the perception of pain and exhaustion could not be influenced by personal characteristics of internal body awareness.

A possible explanation could be that the attention of the participants is shifted from the observation of internal functions onto the virtual room and exercise.

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

Response: That VR provides a new form of reality, where the individual’s is able to exercise for longer with less pain and effort, and by extension this can increase physical activity. One can imagine how beneficial it would be for specific populations, such as athletes or individuals who are reluctant to engage in physical activity, as well as clinical populations where their recovery can be enhanced through physical physiotherapy.

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

Response: Future research may investigate the conditions under which Private Body Consciousness may influence immersion and potentially the effectiveness of VR. For example, more research is needed to determine whether the virtual environments representing natural and photorealistic environments are more or less effective than ones presented in cartoonish form.  Furthermore, it would be worthwhile adopting a mixed-methods approach (questionnaire and interview) in order to address user preferences for the design of VR environments.  Finally,  this  study utilized participants who  were  both  active  and  inactive,  therefore  future  work  should  seek  to replicate  this  study  with  a  group  of  sedentary  participants,  as  this  is  where  the  greatest potential for positive impact on behavior may be. 

No disclosures 

Citation:

Maria Matsangidou, Chee Siang Ang, Alexis R. Mauger, Jittrapol Intarasirisawat, Boris Otkhmezuri, Marios N. Avraamides. Is your virtual self as sensational as your real? Virtual Reality: The effect of body consciousness on the experience of exercise sensations. Psychology of Sport and Exercise, 2018; DOI: 10.1016/j.psychsport.2018.07.004

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