Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

PainRelief.com Interview with:
Dr Stephanie Mathieson
NHMRC Health Professional Research Early Career Fellow
The University of Sydney
Faculty of Medicine and Health, Sydney School of Public Health
Institute for Musculoskeletal Health
Royal Prince Alfred Hospital Australia

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

Response: Chronic non-cancer pain, such as chronic non-specific low back pain has a substantial impact on society by costing billions of dollars each year in health care costs and lost productivity.

Current clinical practice guidelines for the management of chronic non-cancer pain, such as those from the Centers for Disease Control and Prevention, now recommend avoiding the initial use of opioid analgesics, as the risk of harms, such as overdose and death.

We wanted to establish the extent to which opioid analgesics are used by people with chronic noncancer pain. This is important, as many studies report how many opioids are prescribed, but this may not represent the actual use of opioid analgesics.

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Stronger Pain Relief When Patient and Provider Demonstrate Facial Mirroring

PainRelief.com Interview with:
Dan-Mikael Ellingsen PhD
Department of Psychology, University of Oslo
Norwegian Centre for Mental Disorders Research (NORMENT),
Division of Mental Health and Addiction
Oslo University Hospital, Oslo, Norway.

Dr. Ellingsen

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

Response: We know that the patient-clinician relationship can have an important impact on clinical outcomes, but we know relatively little about how this works. A better understanding of the behavioral, physiological, and brain mechanisms behind the patient-clinician interaction may help demystifying the therapeutic relationship and how it influences treatment outcomes.

In order to investigate the behavioral and brain mechanisms involved when patients and clinicians interact, we simultaneously recorded brain activity (using functional MRI) in clinicians and patients with chronic pain, while they underwent a pain treatment session. We also recorded and analyzed non-verbal communication – facial expressions – during the interaction. We found that when the patient and clinician had first established a level of rapport – or therapeutic alliance – through a clinical intake and consultation, they showed stronger concordance in brain activity in brain areas involved in empathy and “theory of mind” (the process of trying to understand other people’s mental states) when they engaged during treatment. We also found that in interactions where the patient and clinician showed more mirroring in facial expressions, the patient also reported higher therapeutic alliance and stronger pain relief from the treatment.

Electro-Acupuncture Can Provide Pain Relief from Chronic Low Back Pain

PainRelief.com Interview with:

Jiang-Ti Kong, MD, Division of Pain Medicine
Department of Anesthesiology, Perioperative and Pain Medicine
Stanford University School of Medicine
Palo Alto, CA

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

Response: Chronic low back pain is the most common chronic pain condition. Its treatment can be challenging, particularly given the side effects from conventional treatments. These include surgical complications and medication side effects, such as opioid dependence and kidney/liver damage. Acupuncture is receiving increasing attention as an alternative treatment for chronic low back pain. However, multiple large studies showed similar effect sizes between real acupuncture and sham (control) acupuncture. Interestingly, most of these studies involve the use of manual acupuncture, while pre-clinical studies suggest the use of electro-acupuncture may lead to greater analgesia than control. Few have formally studied the clinical effect of electro-acupuncture in a randomized, controlled setting. A major objective of our study was to investigate the clinical effect of electro-acupuncture relative to sham control in a randomized, participant- and assessor-blinded, clinical trial.

Acupuncture needle

Equally importantly, we were interested in exploring predictors of clinical response to electro-acupuncture, because, in general, about 40-60% of individuals treated with acupuncture experience clinically significant improvement. It would be helpful to identify responders to acupuncture before treatment initiation. We explored potential predictors of clinical response to electro-acupuncture by performing univariate, treatment heterogeneity and multivariate analysis between baseline participant characteristics and clinical outcome, defined as either pain reduction or improvement in function.

Mindfulness-Based Stress Reduction For Chronic Pain Relief

PainRelief.com Interview with:
Cynthia Marske DO
Good Samaritan Regional Medical Center
Corvallis OR

Cynthia Marske DO Good Samaritan Regional Medical Center Corvallis OR

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

Response:  The background for this study is to explore if there are ways to retrain the brain of those suffering from conditions of chronic pain, with associated anxiety and depression. Since those conditions are common now, have lead to an opioid crisis of misuse and abuse, and treatment for these conditions are often limited.

PainRelief.com: What are the main findings?

Response: The main findings are that self healing is possible, we are often misinformed that the brain and body cannot self heal but we all have the inherent ability to heal ourselves if we believe. One modality of self healing is called mindfulness based stress reduction. First started by Dr John Khabat Zinn in the 1980s at the Massachusetts Hospital. This is a combination of practice of mindfulness, meditation and yoga.

How Do Primary Care Physicians Handle Opioids For Patients Seeking Chronic Pain Relief?

PainRelief.com Interview with:
Laura Militello
Unveil, LLC
Applied Decision Science, LLC

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

Response: Little is known about how primary care clinicians’ (PCC) approach chronic pain management in the current climate of rapidly changing guidelines and the growing body of research about risks and benefits of opioid therapy. When it comes to pain management, primary care clinicians (PCCs) find themselves in a somewhat unexpected role. Few conditions intersect with a range of specialties (i.e. mental health, orthopedics, endocrinology, etc.), disability, and aberrant behavior in the way that chronic pain does. PCCs find themselves in a position where they are asked to assess and diagnose sometimes vague and diffuse pain, and determine appropriate treatment often before the underlying cause of the pain is well-understood.

A recent cultural shift in the U.S. has created a situation in which a formerly default treatment, prescription opioid therapy, is no longer considered safe or appropriate for many patients with chronic pain. The addictive qualities and overall safety profile of opioid medications have come into sharp focus in recent years, leading to a push to reduce opioid use while also trying to achieve pain relief with little guidance for PCCs about how to manage this change in treatment plans. Others have documented the uneasiness many experience in managing patients with chronic pain. One participant in our study described the sense that opioid prescribing sometimes extends into unexpected and disconcerting territory in this way: “I never signed up to be an enforcer.” The complexity and moral uncertainty (6) associated with managing patients with chronic pain is an important backdrop for the findings from this study.

Cognition in Adults Who Use Medical Marijuana for Chronic Pain Relief

PainRelief.com Interview with:
Dr. Sharon R. Sznitman PhD and
Dr. Galit Weinstein, PhD
School of Public Health,
University of Haifa, Haifa, Israel

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

Response: Due to increased media attention related to the topic of medical cannabis and increasing public demand for the treatment, physicians often find themselves in situations where patients and caregivers request medical cannabis treatment. When this demand is from older patients, there is a dearth of studies of effectiveness and risk-benefit ratio as almost no studies have examined the potential therapeutic effects and potential risks of the treatment in this specific group. One of the main implications of cannabis use that researchers have grappled with is its long-term effect on cognitive function. It is well established that cannabis use has detrimental effects on the developing brain when consumed in early life, but detrimental effects of early-life cannabis use may not translate to use in older ages. Use of cannabis in old ages may have adverse effects on cognition but some evidence also exists showing beneficial effects.

Mt. Sinai Study Identifies Lifestyle Changes That Provide Some Knee Pain Relief

PainRelief.com Interview with:
Daniel A Charen MD
Leni and Peter May Department of Orthopaedic Surgery
Icahn School of Medicine at Mount Sinai, New York

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

Response: There is a well-established link between obesity and knee osteoarthritis, and recent research has implicated diabetes as a potential cause of cartilage degeneration. This study uses the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors.

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Are Invasive Procedures Effective for Chronic Pain Relief? A Systematic Review

PainRelief.com Interview with:
Wayne B. Jonas, MD
Executive Director
Samueli Integrative Health Programs, H&S Ventures,
Alexandria, VA

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

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo-controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

Study Finds Chronic Pain Patients Used More Opioids For Pain Relief When COVID-19 Cancelled Elective Procedures

PainRelief.com Interview with:

Dr. Shantha Ganesan MD
 Pain Medicine Specialist
Kings County Hospital Center

David Kim, MD, PGY-2
SUNY Downstate Department of Anesthesiology 

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

Response: The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled.

Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by increasing access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Given the cancellation of elective interventional pain management procedures and relaxed regulations on controlled substances during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time.

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Virus-Delivered Gene Therapy Provides Hope for Neuropathic Pain Relief

PainRelief.com Interview with:
Sujeong Kim, PhD
Institute of BioInnovation Research, Kolon Life Science
Kolon One&Only Tower
Seoul Korea

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

Response: Neuropathic pain (NP) results from a lesion or disease affecting the somatosensory system, according to the International Association (IASP) for the Study of Pain. NP is difficult to treat and drastically influences an individual’s quality of life. Current treatment for NP aims to relieve pain and maintain patient function but does not address the etiological causes or alter the course of the condition. The causes of NP are many and varied in their scope, such as nerve injury, neuroinflammation, and abnormal pain signal transmission. NP has a multifactorial pathogenesis and their pathophysiology is the results of a very complex series of cross-linked pathway. There are limitations in treating pathogenesis by targeting only one path, so simultaneous targeting of multiple elements in NP is crucial for the treatment of the disease. Effective and disease-modifying options for NP treatment are urgently needed. We developed an AAV-based gene therapy, KLS-2031 (developed by KolonLifeScience Inc), for the expression of three therapeutic genes (encoding glutamate decarboxylase 65 (GAD65), glial cell-derived neurotrophic factor (GDNF), and interleukin 10 (IL-10)) to achieve the effective and long-lasting relief of NP.