PainRelief.com Interview with: Dr. Mohamad Bydon MD Professor of Neurosurgery Mayo Clinic Rochester, Minnesota
:Dr. Bydon MD
PainRelief.com: What is the background for this study?
Response: Patients presenting with back or leg pain due to degenerative lumbar spine disease often undergo spinal fusion to mitigate the symptoms and halt the progression of the disease.
PainRelief.com: What are the main findings?
Minimally invasive surgery (MIS) in the lumbar spine encompasses a variety of techniques, such as percutaneous screw placement and operation via tubular retractors, and aims to limit the distortion of patients’ anatomy as much as possible. Eventually, compared to open fusion, MIS fusion is associated with decreased muscle destruction, incision size, and time-to-mobilization.
PainRelief.com Interview with: Dr. Radostin Penchev Johns Hopkins Medicine
PainRelief.com: What is the background for this study? What are the main findings?
Response: Although fewer than 600 people have travelled to space, human space travel is expected to exponentially surge with several companies now offering space excursions as well as with the establishment of the U.S. Space Force in 2019. In parallel with this effort, NASA plans to have a sustained presence on the Moon by 2028.
It turns out that more than 50% of astronauts experience back pain (termed space adaptation back pain) during their mission and are over 4 times more likely to suffer from herniated discs than the normal population. As such, physicians should anticipate a surge in space-related back pathology. More importantly, understanding the cause of back pain in astronauts may also improve the care for other austere environment populations including deep sea divers, fighter pilots and high-altitude explorers.
In this comprehensive review of the literature, we examined the epidemiology, potential causes, and treatments for spinal pain in astronauts.
PainRelief.com Interview with: Caitlin Jones PhD Candidate The University of Sydney Faculty of Medicine and Health, Sydney School of Public Health Institute for Musculoskeletal Health Royal Prince Alfred Hospita Australia
PainRelief.com: What is the background for this study?What are the main findings?
Response: Despite advice being recommended internationally as a treatment for spinal pain, the evidence behind that was uncertain and out of date. We didn’t think that the strong and widespread recommendation to provide advice was reflective of the available evidence. There have been multiple, more recent, trials of advice and education with varying results, so it was a good time to collate and summarise these with a systematic review.
Our main findings were that advice and education had a small effect on pain and disability compared to no advice and education, or placebo in the short term. The effects were around 10 points of improvement for pain and 5 points for disability on a 0 to 100-point scale. There was evidence of no effect at all other time points (immediate, intermediate and long term). The specific content of the advice didn’t seem to make much difference.
We compared simple contemporary advice (such as advice to keep active and to avoid bed rest and reassurance about the positive prognosis) to more comprehensive advice, such as ergonomic advice (specific postural and biomechanical information) or pain neuroscience education, and found them all to be about equally effective. Whether the participants’ symptoms were acute or chronic, the intensity of the intervention in terms of time spent with a therapist, how the intervention was delivered and the depth and type of the content didn’t impact outcomes.
PainRelief.com Interview with: Beth Darnall, PhD Director, Stanford Pain Relief Innovations Lab Associate Professor, Stanford University School of Medicine Department of Anesthesiology, Perioperative and Pain Medicine Psychiatry and Behavioral Sciences (by courtesy) Wu Tsai Neurosciences Institute (affiliate faculty) Palo Alto, CA 94304
Dr. Darnall
PainRelief.com: What is the background for this study? What are the main findings?
Best pain care integrates patient education and tools to help them manage pain and reduce their symptoms1. Multi-session psychological or “behavioral” pain treatment approaches, such as 8-session cognitive behavioral therapy (CBT), are effective for equipping people with pain management skills. However, our prior research showed that patient access to these treatments is often poor, in part due to the costs and time burdens (e.g., up to 16 hours of treatment time).2
Findings from our study suggest that a one-time 2-hour pain relief skills class (“Empowered Relief”) was non-inferior to 8-session CBT for reducing multiple symptoms, including pain catastrophizing, pain intensity, and pain interference at 3 months post-treatment. We also found the single-session pain class imparted substantial reductions for pain bothersome, sleep disturbance, anxiety, fatigue and depression.
PainRelief.com Interview with: Louise Fleng Sandal PhD Adjunkt, Institut for Idræt og Biomekanik SDU University of Southern Denmark
Dr. Sandal
PainRelief.com: What is the background for this study?
Response:Low back pain is a globally prevalent condition with a high economic cost. Many people seek help with primary care from their general practitioner, physiotherapist or chiropractor. Evidence-based guidelines on first line treatment include learning to self-manage, staying active, exercising and learning about the condition. However, many find this difficult without advice and support, but primary care physicians often lack the time and resources to support self-management.
Digital solutions, such as smartphone technology, utilizing artificial intelligence can be used to tailor self-management support to the individual and be available at the individuals convenience.
PainRelief.com Interview with: Christopher M Proctor, PhD Group Leader, Bionic Systems Group BBSRC David Phillips Fellow Electrical Engineering Division University of Cambridge United Kingdom
Dr. Proctor
PainRelief.com: What is the background for this study? What types of pain might be amenable to treatment with this device?
Response: Spinal cord stimulation has been shown to be effective for patients with severe neuropathic pain. However, the most effective devices that are clinically available today require a rather invasive surgical procedure. Our innovation aims to reduce the surgical burden while providing the best possible treatment.
PainRelief.com: Would you describe the technology?
Spinal Implant – Unrolling
Response: Our minimally invasive spinal cord stimulator is an ultra thin implant that can be inserted into the epidural space within the spinal column through a needle. Once in place, the device can be expanded in a controlled way to cover a large area along the spinal cord. Covering a large area allows for more precise targeting of the nerves that cause you to feel pain.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: We believe that this technology could vastly expand the use of spinal cord stimulation for patients with chronic pain conditions. We are currently fundraising to conduct further pre-clinical testing with an aim to be ready for clinical testing within 3 years.
Any disclosures? The main authors of this study are co-inventors on a related patent application.
BY BEN J. WOODINGTON, VINCENZO F. CURTO, YI-LIN YU, HÉCTOR MARTÍNEZ-DOMÍNGUEZ, LAWRENCE COLES, GEORGE G. MALLIARAS, CHRISTOPHER M. PROCTOR, DAMIANO G. BARONE
SCIENCE ADVANCES 25 JUN 2021 : EABG7833
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Benjamin W. Friedman, MD, MS, FAAEM, FACEP, FAHS Professor of Emergency Medicine Vice-chair for Clinical Investigation Department of Emergency Medicine Albert Einstein College of Medicine Montefiore Bronx, NY 10467
PainRelief.com: What is the background for this study? What are the main findings?
Response:A very large number of patients present to US EDs annually with back pain. No medications have proven more effective than NSAIDs for low back pain. Similarly, combining other medications such as skeletal muscle relaxants or opioids with NSAIDs does not improve outcomes more than NSAIDs alone.
Prior to our study, little was known about which NSAIDs were most efficacious for acute low back pain.
The main finding of our study is that ketorolac was more efficacious than ibuprofen for some two and five day outcomes that are important for patients.
PainRelief.com Interview with: Lingxiao Chen | MBBS, MMed, PhD Candidate The University of Sydney Institute of Bone and Joint Research | The Kolling Institute Sydney Medical School | Faculty of Medicine and Health Statistical Editor of BMJ Open Sport & Exercise Medicine
PainRelief.com: What is the background for this study?
Response: Current guidelines for treatment of low back pain (LBP) do not recommend routinely using diagnostic imaging, except when patients either present with severe, progressive neurologic deficits or with signs or symptoms indicative of a serious or specific underlying condition (eg, fracture or cancer). Nonetheless, diagnostic imaging is still widely used in clinical practice for low back pain. Previous studies, using mostly cross-sectional data, provide conflicting evidence of an association between lumbar spine radiographic changes and the severity of back pain–related disability. Such conflicting evidence may be associated with widely unnecessary diagnostic imaging of the lumbar spine.
PainRelief.com Interview with: Christina Abdel Shaheed PhD Researcher and Academic University of Sydney
Dr. Abdel Shaheed
PainRelief.com: What is the background for this study? What are the main findings?
Response:Paracetamol (acetaminophen) is one of the most widely used drugs for pain relief globally. Our study (https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50992) examined the evidence on the efficacy of paracetamol versus placebo for 44 different pain conditions. There is strong evidence paracetamol provides greater pain relief than placebo for four conditions: craniotomy, knee or hip osteoarthritis, tension headache and perineal pain following childbirth, however sometimes the effects were very small.
Paracetamol was no more effective than placebo for acute low back pain. There is uncertainty regarding the benefits of paracetamol for the remaining 39 pain conditions. To note, most studies evaluated single doses of the pain reliever, which does not reflect typical use of the medicine.
PainRelief.com: What should readers take away from your report?
Response: If people are considering paracetamol for their pain, the recommendation is to:
Stick within the safe limits for using paracetamol (maximum 4 g daily for adults, which will vary depending on the formulation used).
Bear in mind there are different types of paracetamol products (long-acting, which should be taken less frequently, versus short-acting); and cold and flu preparations (including decongestant) and popular over-the-counter products for pain relief (including ibuprofen) can also contain paracetamol.
Do not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
Consider combining the medicine with other non-drug strategies to optimise pain relief, particularly for conditions like osteoarthritis e.g. exercise and healthy eating.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response:High quality clinical trials evaluating typical use of paracetamol are needed to resolve the uncertainty around its effectiveness for the majority of pain conditions.
Disclosures: Some of the authors on this study were also involved in the PACE trial which evaluated the efficacy of paracetamol vs placebo for acute low back pain.
Citation:
Abdel Shaheed, C., Ferreira, G.E., Dmitritchenko, A., McLachlan, A.J., Day, R.O., Saragiotto, B., Lin, C., Langendyk, V., Stanaway, F., Latimer, J., Kamper, S., McLachlan, H., Ahedi, H. and Maher, C.G. (2021), The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Med J Aust, 214: 324-331. https://doi.org/10.5694/mja2.50992
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.
PainRelief.com Interview with: Eric Roseen, DC, MSc Director of the Program for Integrative Medicine and Health Disparities Boston Medical Center Assistant Professor of Family Medicine Boston University School of Medicine
PainRelief.com: What is the background for this study?
Response: More than 80 percent of Americans will experience back pain at some point in their lives. Back pain is the leading cause of disability worldwide, and disability and inactivity are generally associated with greater mortality. Women and older adults, and those that experience more severe or persistent back pain, have an elevated risk of back-related disability. We were interested in whether back pain, in general or in these potentially at-risk subgroups, is associated with mortality. Thus, we conducted the first systematic literature review and meta-analysis of the association of back pain and all-cause mortality.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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