Osteoarthritis: Poor Sleep Linked to More Pain

PainRelief.com Interview with:
Dr. Daniel Whibley PhD
Department of Physical Medicine and Rehabilitation
University of Michigan, Ann Arbor, Michigan
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
University of Aberdeen, Scotland, UK

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

Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.

We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening,  these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.

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Low Back Pain Incidence Varies by Occupation

PainRelief.com Interview with:

Sara E. Luckhaupt, MD, MPH
Medical Officer (Epidemiologist)
National Institute for Occupational Safety and Health
Centers for Disease Control and Prevention
CDR, US Public Health Service

ara E. Luckhaupt, MD, MPHMedical Officer (Epidemiologist)
 National Institute for Occupational Safety and Health
 Centers for Disease Control and Prevention
 CDR, US Public Health Service

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

  • In 2015, 26.4% of U.S. workers (nearly 40 million people) reported experiencing any low back pain (LBP) in the past 3 months; frequent and severe low back pain was reported by 8.1% of workers.
  • Many of these cases (more than 20%) were attributed to work by a health professional, but most workers affected did not discuss work-relatedness with their providers.
  • Regardless of the cause, low back pain affected many current workers’ ability to work.
  • 16.9% of workers with any low back pain and 19.0% of those with frequent and severe low back pain missed at least 1 full day of work in the past 3 months because of LBP.
  • 6.1% of workers with any low back pain and 10.7% of those with frequent and severe LBP had stopped working, changed jobs, or made a major change in work activities in the past 3 months because of their LBP
  • The burden of low back pain among workers varied by occupational group.
  • The proportion of workers who reported any low back pain and work-related LBP was highest in construction and extraction occupations; 31.6 percent of these workers reported any low back pain and 12.3% reported work-related LBP.
  • The proportion of workers reporting frequent and severe low back pain was highest in building and grounds cleaning and maintenance occupations; 11.4% of these workers reported frequent and severe low back pain .

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

  • Low back pain among workers is a substantial problem.
  • Many cases of low back pain among workers have been attributed to work, but work-relatedness may be under-recognized.
  • Identifying an association with work may improve the chances of a patient’s recovery if an aspect of their job contributing to the pain can be reduced or eliminated.

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

  • We did not examine the relationship between obesity and low back pain in our study but low back pain has been found to be associated with obesity in other studies.  Other research in this area could be helpful.
  • Future research could also examine which aspects of various jobs are most highly associated with LBP and best practices for healthcare providers to recognize and address work-related low back pain .

Citation:

Prevalence, Recognition of Work-Relatedness, and Effect on Work of Low Back Pain Among U.S. Workers

Sara E. Luckhaupt, MD, MPH; James M. Dahlhamer, PhD; Gabriella T. Gonzales, BS; Ming-Lun Lu, PhD; Matthew Groenewold, PhD; Marie Haring Sweeney, PhD; Brian W. Ward, PhD

Published: Ann Intern Med. 2019.

DOI: 10.7326/M18-3602

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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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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.

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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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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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