Category Archives: Chronic Pain

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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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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Gene Linked to Efficacy of Gabapentin for Chronic Pelvic Pain Identified

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PainRelief.com Interview with:
Dr Lucy ​H R Whitaker (BSc (Hons) MB ChB MSc MD MRCOG)
Senior Clinical Research Fellow and Honorary Consultant Gynaecologist
Centre for Reproductive Health,
Institute for Regeneration and Repair 
Edinburgh BioQuarter 
Edinburgh 

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

Response: Our study focused on chronic pelvic pain in women, a common condition affecting up to one in four women, for which there are few evidence-based treatment options. We previously conducted a multicentre randomised controlled trial (GaPP2) to assess the effectiveness of gabapentin, a commonly prescribed painkiller, in relieving chronic pelvic pain.

The trial found that gabapentin did not relieve pain and was associated with more side effects compared to a placebo. However, to better understand why some women respond to gabapentin more than others, we studied the DNA of the participants from the GaPP2 trial to identify genetic changes that might affect response to gabapentin.

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Chronic Pain Conditions Among Women in the Military Health System

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PainRelief.com Interview with:
Andrew J. Schoenfeld, MD
Professor, Harvard Medical School
Orthopaedic Surgery
Brigham and Women’s Hospital 

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

Response: The impetus for this research stems from my time as the Director of the Medical Evaluation Board at Fort Bliss Texas during my time on active duty with the Army between 2009-13 and my time in Ann Arbor VA between 2013-15.  We wanted to understand the impact that repeated exposure to the high intensity deployment to combat theaters during 2006-2013  had on women active duty servicemembers and women civilian dependents of active duty servicemembers who were deploying

PainRelief.com: What are the main findings?

Response: Significant increases in the diagnosis of Chronic Pain conditions among women active duty service members as well as women civilian dependents who were affiliated with the military between 2006-13.

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Chronic Pain Improved in TBI Patients Receiving Collaborative Care

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PainRelief.com Interview with:
Jeanne M. Hoffman, PhD, ABP
Professor, Department of Rehabilitation Medicine
University of Washington School of Medicine  

dr_jeanne_m_hoffman

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

Response: We were interested in finding a way to improve the treatment of pain for individuals with traumatic brain injury who often struggle with chronic pain, but may not always be able to benefit from the therapies that are available. 

PainRelief.com: What are the main findings?

Response: We found that using an approach called “collaborative care”, which is an integrated, team-driven approach to delivering patient-centered evidenced based care that, in our study, included 12 sessions of cognitive behavioral treatment of pain, led to improvements in pain interference at the end of treatment, which lasted an additional 4 months after treatment ended. 

We also found improvements in pain intensity after treatment as well as reductions in the collaborative care group in symptoms of anxiety and depression and increases in satisfaction with care.

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Cincinnati Children’s Hospital Study Addresses How Early Life Surgery Can Influence Later Responses to Pain

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PainRelief.com Interview with:
Michael P. Jankowski, PhD
Theodore W. Striker, MD Chair in Anesthesia Research
Professor and Director of Research
Department of Anesthesia, Division of Pain Management
Cincinnati Children’s Hospital Medical Center

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

Response: It is estimated that chronic pain can affect up to 20% of children undergoing surgery.  We know that alterations in sensory input during critical periods of development can have lasting effects on normal sensory processing later in life.  The developing peripheral nervous system undergoes substantial changes in function during the neonatal period as it receives information from the external environment.  Injuries, including surgery, that occur during this early developmental window can change the way a patient responds to re-injury in adolescence and young adulthood, a phenomenon called neonatal nociceptive priming. 

         At the same neonatal time, the immune system is also developing and responding to changes in the body.  Surgery is known to cause an immune response that is normally activated to facilitate wound healing and regulate acute pain so that the tissues can undergo proper repair after damage.  However, it was not clear how early life surgery could affect the developing immune system to influence pain responses later in life. 

         Since we knew that one particular type of immune cell, the macrophage (which regulates inflammation and tissue repair in addition to acute pain), can play a role in long term responses to surgery, we investigated how this cell type may play a role in the transition from acute post-surgical pain in neonates to prolonged responses to reinjury later in adolescence. 

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Empathetic Care By Physicians Provides Better Pain Relief Than Most Other Modalities

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PainRelief.com Interview with:
John C. Licciardone, DO, MS, MBA, FACPM
Regents Professor and Richards-Cohen Distinguished Chair in Clinical Research
Department of Family Medicine, MET-568
University of North Texas Health Science Center
Fort Worth, TX 76107

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

Response: The Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation focuses on the patient-physician relationship and its association with chronic pain treatment and outcomes.

Previous studies involving physician empathy often have been limited to pain clinics and involved short-term follow-up. Our study aimed to study the impact of physician empathy on outcomes among patients with chronic low back pain in community settings throughout the United States over 12 months of follow-up.

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

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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

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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

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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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