Cleveland Clinic Study Finds Virtual Yoga Effective Way to Manage Chronic Low Back Pain, with Added Benefit of Flexibility

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PainRelief.com Interview with:
Hallie Tankha, Ph.D., Research faculty
Department of Wellness and Preventive Medicine 
Cleveland Clinic, and first author of the study

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

Response: Numerous studies have highlighted the benefits of yoga for individuals with chronic low back pain, including reductions in pain intensity, improvements in daily functioning (such as walking or climbing stairs), and better sleep quality. However, these studies used in-person yoga sessions. With the onset of the COVID-19 pandemic, healthcare delivery had to adapt quickly, and yoga was no exception. As virtual healthcare options continue to expand, this led us to wonder: could virtual yoga offer the same benefits as in-person classes for chronic low back pain?

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Study Finds Back Pain May Be Eased by Reduced Sitting

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PainRelief.com Interview with:
Jooa Norha, MSc (Health Sciences), PT
Doctoral researcher
Turku PET Centre
University of Turku, Finland

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

Response: The previous evidence linking sedentary behavior (or sitting to simplify) and back pain is surprisingly scarce. Therefore, we wanted to investigate whether reducing sitting could help with back pain among adults who sit for major parts of the day. And indeed, we did find that reducing sitting for about 40 min/day for six months kept back pain from worsening.

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Yale Study Evaluates Long-Term Use of Muscle Relaxant Medications for Chronic Pain

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PainRelief.com Interview with:
Benjamin Oldfield, MD MHS
Vice President of Clinical Affairs
Program in Addiction Medicine
Department of Medicine
Yale School of Medicine
New Fair Haven Community Health Care
New Haven, Connecticut

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

Response: Stricter opioid prescribing guidelines have been associated with more prescriptions of other (non-opioid) classes of medicines for pain, and particularly for chronic pain. Muscle relaxant medications (a class of medications that includes, for example, cyclobenzaprine, tizanidine, and others) have gotten very popular in the last several years.

By some measures, prescriptions for this class of medicines doubled between 2005 and 2016, and physician visits for continuing muscle relaxant medications tripled during the same period. However, this class of medications is generally indicated for acute pain, in short courses (not for chronic pain, in longer courses). So, we set out to analyze all the literature to ask—what is the safety and efficacy of this class of medications for chronic pain, in longer courses (1 month or more)?

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Mass General Study Evaluates AI Models of Pain Management For Racial, Ethnic or Sex Bias

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PainRelief.com Interview with:
Marc D. Succi, MD
Strategic Innovation Leader | Mass General Brigham Innovation
Associate Chair of Innovation & Commercialization | Mass General Brigham Enterprise Radiology
Co-Director, Innovator Growth Division, Mass General Brigham Innovation
Attending Radiologist | Mass General Emergency Radiology 
Assistant Professor of Radiology | Harvard Medical School
Executive Director, Mass General Brigham MESH Incubator

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

Response: This study investigates whether large language models (LLMs), such as GPT-4 and Google’s Gemini, introduce racial, ethnic, or sex-based bias when recommending opioid treatments for pain management. Existing literature highlights racial disparities in pain treatment, with Black patients often receiving less aggressive pain management compared to White patients.

LLMs, as AI tools trained on large datasets, may either perpetuate these biases or help standardize treatment across diverse patient groups. This study analyzed hundreds of real-world patient cases, representing various pain conditions, to assess if race, ethnicity, or sex influenced the LLMs’ opioid treatment recommendations.

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NEJM: Trial of A Monoclonal Antibody to PACAP for Migraine Prevention

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PainRelief.com Interview with:
Professor Messoud Ashina, MD, PhD, DMSc
Department of Neurology and Danish Headache Center
Glostrup Hospital
University of Copenhagen, Glostrup
Copenhagen, Denmark

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

Background and Main Findings: Current migraine treatments targeting CGRP aren’t fully effective for everyone. PACAP is another key molecule implicated in migraine and can trigger migraine attacks. Lu AG09222, an antibody that blocks PACAP, has shown promise in reducing migraine days in a phase 2a trial.

Effects Duration: 4 weeks.

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Mindfulness-Based Interventions Delivered via Telehealth Improved Pain and Well-Being Among People with Chronic Pain

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PainRelief.com Interview with:
Diana Burgess, PhD
Director of the VA Advanced Fellowship Program in Health Services Research
CCDOR: Center for Care Delivery and Outcomes Research
Director of the VA QUERI Complementary and Integrative Health Evaluation Center (CIHEC)
Professor of Medicine at the University of Minnesota

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

Response: Mindfulness is being aware and paying attention in a kind, non-judgmental way, to what is happening in the present moment. Mindfulness-based interventions teach people mindfulness skills, through a variety of practices, such as meditation and mindful movement. Although mindfulness interventions are evidence-based treatment for chronic pain and conditions that often accompany pain, like anxiety and depression, many MBIs are difficult to implement at scale in healthcare systems as they require trained mindfulness instructors, dedicated space and pose barriers to patients due to the time commitment involved. We wanted to develop MBIs that were relatively low resource, scalable and more accessible for patients. 

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Study Finds Sex Bias in Pain Management in Emergency Departments

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PainRelief.com Interview with:
Mika Guzikevits
Doctoral Student
Prof. Choshen-Hillel’s Decision-Making lab
School of Business Administration & Federmann Center for the Study of Rationality 
The Hebrew University of Jerusalem

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

Response: Although pain is one of the most common reasons for seeking medical help, providing adequate treatment can be challenging due to its subjective nature. When healthcare providers’ pain management decisions rely on subjective judgment, they are susceptible to biases.

PainRelief.com: What are the main findings?

Response: Our study, which analyzed over 21,000 patient records from the United States and Israel, found a significant sex bias in pain management at emergency departments. We found that female patients are consistently less likely to receive pain relief prescriptions compared to male patients with similar complaints (around 10% difference). This bias persists across different ages, pain levels, and physician sex, indicating a systemic issue. Female patients’ pain scores are less frequently recorded, and they spend more time in the emergency department than male patients. In a controlled experiment involving 109 nurses, we found that pain was rated as less intense if the patient was said to be female rather than male, which supports our hypothesis that healthcare providers are susceptible to stereotypical beliefs about women’s pain and expect them to act “hysterically” and exaggerate their pain reports.

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UNC Scientists Identify Specific Brain Circuits Mediating Placebo Pain Relief

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PainRelief.com Interview with:
Grégory Scherrer, PharmD, PhD
University of North Carolina at Chapel Hill
Depts of Cell Biology and Physiology, of Pharmacology
UNC Neuroscience Center

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

Response: The placebo effect is a fascinating phenomenon where a person’s positive expectations can lead to real changes in their physical or psychological state, even without active treatment. A specific aspect of this phenomenon is placebo analgesia, where the expectation of pain relief results in an actual reduction in pain perception. Placebo analgesia demonstrates the intricate power of the human brain that can be harnessed for pain control. However, despite extensive research, the neural mechanisms underlying placebo analgesia remain largely unclear.

Our study aimed to explore the neural circuits mediating placebo analgesia, using an innovative mouse model to mimic the human placebo analgesia. By doing so, we hoped to uncover how certain brain regions interact to produce pain relief through expectation alone, potentially opening new avenues for pain control by manipulating these circuits.

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VA Evaluates Use of Massage Therapy for Pain Relief

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PainRelief.com Interview with:
Dr. Selene Mak Ph.D, MPH
Program Manager in the Evidence Synthesis Program
VA Greater Los Angeles Healthcare System

Dr. Selena Mak
Dr. Selena Mak

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

Response: The Department of Veterans Affairs is committed to providing evidence-based treatments.  One way VA pursues this is through rigorous examinations of the evidence about potential therapies.  Massage therapy is one such therapy being examined. 

VA previously produced an evidence map of massage therapy for pain, which included systematic reviews published through 2018. However, new evidence is constantly appearing and to categorize the newer evidence base for use in decision-making by policymakers and practitioners, VA policymakers requested a new, updated evidence map of systematic reviews published since 2018 to answer the question “What is the certainty of evidence in systematic reviews of massage therapy for pain?”

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Experimental “bitopic” Opioid Suppresses Pain With Fewer Side Effects

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PainRelief.com Interview with:

Susruta Majumdar, PhD
Professor in the Department of Anesthesiology
Washington University School of Medicine
Nokomis Ramos-Gonzalez, PhD
Postdoctoral Trainee in the Majumdar Lab
Washington University School of Medicine
Balazs R. Varga PhD
Center for Clinical Pharmacology
University of Health Sciences & Pharmacy at St. Louis
Department of Anesthesiology and Washington University Pain Center
Washington University School of Medicine
St. Louis, Missouri 63110

Jay McLaughlin, Ph.D
Professor of Pharmacodynamics
College of Pharmacy
University of Florida

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

Response:    Opioid medications tap into the body’s natural system for mitigating pain by activating pain-suppressing opioid receptors on neurons. Although meant to help, sometimes these medications do harm.  Opioid medications offer people relief from debilitating pain, but these drugs come with dangers: the risk for addiction, miserable withdrawal symptoms and the potential for fatal overdose.  New mechanistic insights into the function and regulation of the opioid receptors present the opportunity to design new, safer opioid painkillers. The team’s previous research utilized a strategy to design functionally selective “bitopic” opioids by targeting the sodium binding allosteric site in the opioid receptor.

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