Study Evaluates Long-Acting Bupivacaine for Pain Relief During Knee Replacement

PainRelief.com Interview with:
Prof. Hemant G. Pandit, DPhil
Leeds Institute of Rheumatic and Musculoskeletal Medicine
Chapel Allerton Hospital, University of Leeds
Leeds, United Kingdom

Prof. Pandit

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

Response:  Knee replacement is highly successful for treating severe arthritis. There are 100,000 people who undergo knee replacement surgery every year in the UK, with numbers set to rise significantly in future. It remains however a painful procedure with nearly half of patients reporting severe pain post-operatively. Currently pain control is provided by injecting a local anaesthetic of bupivacaine hydrochloride around the knee during surgery providing good pain relief for 12 to 24 hours. However, patients typically experienced the worst pain the next morning when they are encouraged to bend their knee and get out of bed. 

Liposomal bupivacaine is a local anaesthetic preparation which can provide sustained release of pain relief medication over a longer period of time (up to 72 hours). The drug is costly and is used in routine clinical practice in the USA with previous studies showing varying results with the use of LB. We therefore (researchers at the Universities of Oxford and Leeds) developed the SPAARK (Study of Peri-Articular Anaesthetic for Replacement of the Knee) Trial, to test whether liposomal bupivacaine would be more effective at managing the pain compared to current treatments in patients undergoing a knee replacement. 

Psychological Interventions For Non-Specific Chronic Low Back Pain

PainRelief.com Interview with:

Ms Emma Ho | BAppSc(Phty)(Hons), PhD Candidate
The University of Sydney                                          
Faculty of Medicine and Health | Charles Perkins Centre Musculoskeletal Research Hub | Sydney NeuroMusculoskeletal Research Collaborative
Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences

Emma Ho

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

Response: Adults with chronic low back pain (lasting for more than 12 weeks) not only experience physical disability but can also suffer psychological distress in the form of anxiety, depression, and fear avoidance (avoiding movement for fear of pain).

Clinical guidelines therefore consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain. However, not much is known about the different types of psychological therapies available as well as their comparative effectiveness and safety, leaving doctors and patients often unclear about the best choice of treatment. Accordingly, the aim of our systematic review with network meta-analysis was to determine the comparative effectiveness and safety of psychological interventions for chronic non-specific low back pain.

Pharmacists May Play An Important Role in Pain Management

PainRelief.com Interview with:
Nathorn (Nui) Chaiyakunapruk PharmD, PhD
Professor, Department of Pharmacotherapy
University of Utah College of Pharmacy
Salt Lake City, UT 84112

Dr. Chaiyakunapruk

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

Response: Pain and pain-related diseases are the major causes of disability and disease burden worldwide. Over the last two decades, as the role of the pharmacist has expanded, pharmacist engagement in disease state management including pain management has been shown to improve clinical outcomes. Several systematic reviews have been conducted to date that assessed the impact of pharmacist interventions on pain management. However, the evidence on the effect of any type of pharmacist intervention, whether led by a pharmacist or in a supportive role, on pain intensity over time in individuals with pain of any etiology is currently inadequate. This study aims to fill that gap.

Study Identify Mechanism That Converts Normal to Chronic Pain

PainRelief.com Interview with:
Dr. Daniela Mauceri PH.D.
Neurobiology
Heidelberg University
Heidelberg Germany

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

Response: Physiological, normal, pain prevents damage to the tissues and, in case of injury, resolves with healing. Pathological, chronic pain however, will persist after injury is mended and can manifest even in absence of causes. The transition from physiological to chronic pain is sustained by alterations of gene expression in the cell belonging to the pain circuitry such as neurons of the dorsal horn spinal cord. Epigenetic changes are important mechanisms regulating gene transcription in mammalian cells and had been previously implicated in pain chronification. A detailed understanding of which epigenetic mechanism would be critical in the establishment of chronic pain was still missing and the identity of the regulated genes still elusive.


PainRelief.com:  What are the main findings?

Response: In our study we described how one particular epigenetic molecule named Histone Deacetylase 4 (HDAC4) is inactivated in the neurons of the dorsal horn spinal cord in persistent inflammatory pain. We also showed that inactivation of HDAC4 leads to increased expression of Organic Anion Transporter 1 (OAT1) and found that OAT1 is responsible for the mechanical hypersensitivity typical of chronic pain. 

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

Response: Our study suggests that finding ways to maintain HDAC4 in an active state might prevent pain chronification by blunting the upregulation of OAT1. Alternatively, blocking OAT1 activity with a pharmacological approach might also be beneficial.

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

Response: Chronic pain is a severe pathological condition affecting a considerable part of the worldwide population. Treatments are still unsatisfactory. Our study, although performed using a mouse model of chronic inflammatory pain puts forward two potential new candidates (HDAC4, OAT1) for not only future investigations but also, importantly, for the development of future therapeutic approaches.

The research work was funded by the CRC1158 on Chronic Pain by the German Research Foundation.

Citation:

Litke, C., Hagenston, A.M., Kenkel, AK. et al. Organic anion transporter 1 is an HDAC4-regulated mediator of nociceptive hypersensitivity in mice. Nat Commun 13875 (2022). https://doi.org/10.1038/s41467-022-28357-x

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MORE Study Integrates Mindfulness for Opioid Misuse and Chronic Pain in Primary Care

PainRelief.com Interview with:
Eric L. Garland, PhD LCSW
Distinguished Endowed Chair in Research
Distinguished Professor and Associate Dean for Research
University of Utah College of Social Work
University of Utah, Salt Lake City
www.drericgarland.com

Dr. Garland

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

Response: This was a 5-year NIH-funded clinical trial conducted in the primary care setting. Mindfulness-Oriented Recovery Enhancement reduced opioid misuse by 45%, more than doubling the effect of standard supportive psychotherapy, and far exceeding the effect size of any known therapy for opioid misuse among people with chronic pain. At the same time, MORE decreased chronic pain symptoms to a greater extent than the current gold-standard psychological treatment for chronic pain, CBT. MORE also decreased emotional distress and depression.

Risk of Low Back Pain in Women May Vary with Age of Menarche

PainRelief.com Interview with:
Ingrid Heuch MD, PhD
Department of Research, Innovation and Education,
Division of Clinical Neuroscience
Oslo University Hospital, Norway

Dr. Heuch

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

Response: Low back pain represents a major health problem in today’s society. In this study more than 27 000 women aged 20-69 years were included in the Trøndelag Health Study, HUNT, in Norway. As in most population-based studies, women were more likely to be affected with chronic low back pain than men. Our study showed a U-shaped relationship between age at menarche (age at a woman’s first menstruation) and risk of low back pain, also after many years. Both women with an early or late age at menarche experienced higher risk of low back pain. Compared to women with menarche at age 14 years, menarche at age 11 years increased the risk by 32% and menarche at age 17 years by 43%. No association was found between age at menopause and risk of low back pain.

As Opioid Prescriptions Fall, Alternate Prescriptions for Pain Relief Increase

PainRelief.com Interview with:
Lauren R. Gorfinkel MPH
New York State Psychiatric Institute
New York, NY
Department of Medicine, University of British Columbia
Vancouver, Canada

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

Response: The opioid crisis has led to clear declines in opioid prescribing across North America, however, chronic pain remains an extremely common health problem with limited treatment options. This study was therefore interested in using nationally-representative data to find out whether alternative pain medications are growing more popular as opioid prescriptions decline.

NEJM: Study Recommends Hip Implants Be Fixed with Bone Cement

PainRelief.com Interview with:
Matthew Costa
Professor of Orthopaedic Trauma Surgery
University of Oxford 
Honorary Consultant Trauma Surgeon
John Radcliffe Hospital, Oxford

Dr. Costa

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

Response: The number of patients sustaining a fracture of the hip is increasing rapidly as patients all around the world live into older age. It estimated there will be over 6 million hip fractures by 2050. Approximately half of hip fractures occur at the neck of the thigh bone (femur) and the majority of patients over 60 years with such a fracture are treated with a partial hip replacement in which the head of the femur is replaced with a metal implant (hemiarthroplasty).

There is controversy about how best to fix the hemiarthroplasty implant to the bone of the femur. If the implant is not securely bonded to the patient’s bone it can loosen causing pain and restricting movement and activities of daily living. This study was about the best way to fix the implant to the patient’s bone.

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Many Young Adults and Adolescents Vape Both Tobacco and Cannabis

PainRelief.com Interview with:
Ruoyan Sun PhD
Assistant Professor
School of Public Health
The University of Alabama at Birmingham

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

Response: Many people consider vaping as just nicotine vaping, but these vaping devices can be used to vape cannabis as well. We are curious about how many e-cigarette users are vaping cannabis. Using the Population Assessment of Tobacco and Health (PATH) study from 2018 to 2019, we investigated the proportion of current (past 30-day) e-cigarette users (ages 12-24) who vaped cannabis and their frequency of cannabis vaping.  

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Identification of the Muscle-Relaxant Carisoprodol (Soma) and Non-Controlled Prescription Substances in Drug-Arrests

PainRelief.com Interview with:
Maaz Siddiqui, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania

Maaz Siddiqui

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

Response: Over the last twenty years, the rise of deaths due to drug overdoses have been mainly and rightfully attributed to opioids. However, many investigations identify non-opioid drugs and drug classes that additionally contribute to deaths due to polysubstance overdoses. Through the Maine Diversion Alert Program (DAP) data, we examined drugs that often escape the attention of healthcare providers and directly or indirectly contribute to substance misuse, arrests, addiction, and deaths due to overdose.

The goal of this study was to utilize a novel dataset to uncover and identify the noncontrolled drugs that have shown potential to be misused.

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