Back Pain: Study Analyzes Course of Acute, Subacute and Chronic Low Back Pain

PainRelief.com Interview with:
Prof. Lorimer Moseley PhD

DSc, FAAHMS, FACP, HonFFPMANZCA, HonMAPA, BAppSc(Phty)(Hons)
Professor of Clinical Neurosciences
Foundation Chair in Physiotherapy
University of South Australia 
Chair of PainAdelaide Stakeholders’ Consortium

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

Response: 12 years ago, members of our group gathered all the research studies that had followed people with back pain for a year and used all the combined data to get an idea of how well people with back pain do. That big study concluded that if you have had back pain for less than 6 weeks, you were highly likely to do really well and that if you had back pain for more than 6 weeks, things were still likely to go pretty well. That made us think ’so why do so many people have chronic back pain?’

Perhaps, by lumping sub-acute back pain (6-12 weeks) in with chronic back pain (>12 weeks) that study 12 years ago made outcomes for people with over 12 weeks of back pain look better than they really were. We decided to repeat that big study from 12 years ago but because there were likely to be many more research studies, we decided to divide the participants into three groups: those with back pain for less than 6 weeks, those with back pain for 6-12 weeks and those with back pain for more than 12 weeks. 

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Rutgers Study Evaluates Telehealth Delivered Mindfulness Therapy in OUD Patients with Chronic Pain

PainRelief.com Interview with:
Nina A. Cooperman, PsyD
Department of Psychiatry
Division of Addiction Psychiatry
Rutgers Robert Wood Johnson Medical School
Piscataway, New Jersey

Dr Nina Cooperman, Photo by John O’Boyle

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

Response: This study aimed to evaluate the impact of a novel intervention, Mindfulness Oriented Recovery Enhancement (MORE), on opioid use and chronic pain among individuals receiving methadone treatment (MT).

The main goal of this study was to conduct a clinical trial to assess online MORE, delivered remotely, through secure video or phone conferencing, with respect to a range of clinical outcomes.

This study will involve a 2-arm individually randomized controlled trial design that compares MORE and treatment as usual (TAU). 

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Opioids Associated with Higher Risk of Mortality in Patients with Kidney Disease and Chronic Pain

PainRelief.com Interview with:
Satya Surbhi, PhD
Assistant Professor, Division of General Internal Medicine, Department of Medicine
and Center for Health System Improvement, College of Medicine
Director of Measurement and Reporting, Tennessee Population Health Consortium
University of Tennessee Health Science Center

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

Response: Pain is highly prevalent among individuals with chronic kidney disease (CKD), in whom commonly utilized analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs) are often contraindicated. Opioids can be an alternative means of analgesia in patients with CKD, but they are associated with numerous unwanted adverse effects and current efforts are aimed at curbing opioid use in general, which leaves patients with few choices for analgesia. Non-opioid non-NSAID analgesics (e.g., gabapentin, acetaminophen, antipyrine) represent potential alternative choices, but their long-term outcomes in CKD compared to opioids are unknown.    

The objectives of this study were to

1) compare the association of chronic opioid vs. non-opioid analgesics with end-stage kidney disease (ESKD) and all-cause mortality among patients with CKD and chronic pain and

2) to examine the heterogeneity of treatment effects on outcomes by factors including age, sex, race, smoking status, BMI, cancer, eGFR and UACR levels, benzodiazepine use, and opioid/non-opioid prescription year. 

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Study Assesses Quality of Life After Cannabis Prescribed for Chronic Pain and Other Health Symptoms

PainRelief.com Interview with:
Margaret-Ann Tait | PhD candidate
Project Manager, The QUEST Initiative
Research Manager, Faculty of Medicine and Health
Sydney Nursing School, Cancer Care Research Unit
University of Sydney

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

Response: In 2016 Australia passed legislation that allows cannabis use for medicinal purposes. Since then, an estimated 800,000 patients have received medicinal cannabis prescriptions. We wanted to know if patients with chronic health conditions in Australia are reporting their health outcomes differently after being prescribed medicinal cannabis. We used validated questionnaires to assess their health-related quality of life, levels of fatigue, pain, sleep disturbance, anxiety, and depression before starting therapy and then at regular intervals for three months after. 

We had 2327 patients participating from across Australia aged between 18 and 97 (the average age was 51), and nearly two thirds were female. Half of our participants were prescribed medicinal cannabis for more than one condition, with chronic pain conditions reported more frequently, followed by insomnia, anxiety, and mixed anxiety & depression.

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Nerve Pathway Identified That May Mitigate Pain from Endometriosis

PainRelief.com Interview with:
Robert N. Taylor, MD PhD
Professor of Obstetrics and Gynecology
Investigator, Clinical and Translational Research Center
Jacobs School of Medicine and Biomedical Sciences
University at Buffalo

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

Response: Our laboratory has been interested in the hormonal modulation of endometriosis-associated pain for decades. This disease and its manifestations are multifactorial. In the current study we focused on the role of nerve growth factors and their receptors, interactive proteins that direct the growth of new nerves and allow their circuits to communicate to regions of the brain that sense pain.

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NEJM: Vertex Pharma Study Demonstrates Potential for First-in-Class Non-Opioid Treatment For Moderate to Severe Acute Pain

PainRelief.com Interview with:
Vertex Pharma Company Spokesperson

PainRelief.com: What is the background for this study? How does VX-548 work?

Response: VX-548 is an oral, selective NaV1.8 inhibitor that is highly selective for NaV1.8 relative to other NaV channels. NaV1.8 is a voltage-gated sodium channel that plays a critical role in pain signaling in the peripheral nervous system. NaV1.8 is a genetically validated target for the treatment of pain, and Vertex has previously demonstrated clinical proof-of-concept with a small molecule investigational treatment targeting NaV1.8 in multiple pain indications including acute pain, neuropathic pain and musculoskeletal pain.

 Vertex’s approach is to selectively inhibit NaV1.8 using small molecules with the objective of creating a new class of medicines that have the potential to provide superior relief of pain without the limitations of opioids, including their addictive potential. VX-548 is the most advanced NaV1.8 inhibitor in Vertex’s program.

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NYU Lab Harnesses Gene Therapy to Tackle Chronic Pain

PainRelief.com Interview with:
Rajesh Khanna, PhD

Director, NYU Pain Research Center
Professor, Department of Molecular Pathobiology
Professor, Department of Neuroscience and Physiology
Investigator, Neuroscience Institute
New York University


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

Response: Chronic pain affects an estimated 20-30% of the global population, significantly impacting quality of life and mental health. It poses substantial socioeconomic burdens, with costs relating to healthcare and lost productivity. Despite its prevalence, chronic pain remains underdiagnosed and undertreated worldwide, highlighting a crucial need for enhanced awareness, research, and therapeutic strategies.

Among the many targets being pursued for the development of drugs against chronic pain conditions are key proteins in neurons that are involved in the signaling of pain. A key family of these targets is the voltage-gated sodium channel family. Among them, the Nav1.7 sodium channel plays a critical role in the development and maintenance of chronic pain. It is an integral part of the peripheral nervous system and is highly expressed in nociceptive (pain-sensing) neurons, including the dorsal root ganglia and sympathetic ganglion neurons.

Nav1.7 channels act as a threshold channel, amplifying small sub-threshold depolarizations and generating action potentials, which are the electrical signals responsible for transmitting sensory information, including pain, to the brain. In essence, they work as a key amplifier of signals from peripheral pain-sensing neurons to central pain pathways.

Certain genetic mutations that cause either a gain or loss of Nav1.7 function can lead to conditions associated with altered pain perception. Gain-of-function mutations, which increase the activity of the channel, can lead to pain syndromes like Inherited Erythromelalgia (IE) and Paroxysmal Extreme Pain Disorder (PEPD). In contrast, loss-of-function mutations, which decrease or eliminate the activity of Nav1.7, result in Congenital Insensitivity to Pain (CIP), a condition where individuals are unable to feel pain.

Given this integral role, Nav1.7 has become a focus of interest as a target for new analgesic drugs. The development of Nav1.7 inhibitors could offer a new avenue for more effective and targeted treatment strategies for chronic pain conditions. It’s a promising area of research, though there are still challenges to be met, such as achieving sufficient specificity for the Nav1.7 channel to avoid side effects associated with other sodium channels.

In the NYU Pain Research Center in the College of Dentistry at New York University (https://dental.nyu.edu/research/pain-research-center.html), the Khanna lab is pursuing alternative ways to target Nav1.7 for pain relief.

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Study Finds More Than 10 Million New Cases of Adult Chronic Pain Per Year

PainRelief.com Interview with:
Richard L. Nahin, MPH, PhD

National Center for Complementary and Integrative Health
National Institutes of Health, Bethesda, Maryland

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

Response: While there has been extensive research examining the prevalence of chronic pain, far less is known about the incidence of chronic pain.  Understanding the incidence of chronic pain is critical to understanding how such pain manifests and evolves over time.

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COCHRANE: Poor Evidence for Prescription Antidepressants for Pain Relief

PainRelief.com Interview with:
Professor Tamar Pincus PhD
Professor in Health Psychology
Dean of the Faculty of the Environment and Life Sciences
University of Southampton

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

Response: Antidepressants are recommended by guidelines for many chronic pain conditions. The most common prescribed antidepressant in amitriptyline. We carried out the largest and most systematic review of all antidepressants for all pain condition, at any dose, to test whether they were effective at reducing pain, increasing physical function, and improving mood and sleep. We reviewed 176 trials with almost 30,000 participants. We rated each study for its methodology so we could rank each drug according to how much we could be certain of the evidence.

Chronic Multifocal Pain Linked to Accelerated Cognitive Decline

PainRelief.com Interview with:
Yiheng Tu
CAS Key Laboratory of Mental Health
Institute of Psychology
Chinese Academy of Sciences
Department of Psychology
University of Chinese Academy of Sciences
Beijing, China

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

Response: Chronic pain (CP) is a leading source of disability worldwide. Multisite chronic pain, where pain is experienced in multiple anatomical locations, affects almost half of chronic pain patients and has been found to have a greater burden on patients’ overall health. However, However, it has not been clear whether people with multisite chronic pain suffered from aggravated neurocognitive abnormalities.