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

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

David Kim, MD, PGY-2
SUNY Downstate Department of Anesthesiology  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 Interview with:
Sujeong Kim, PhD
Institute of BioInnovation Research, Kolon Life Science
Kolon One&Only Tower
Seoul Korea  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.

Deprescribing Opioids Used For Chronic Non-Cancer Pain Relief Interview with:
Dr Stephanie Mathieson PhD
NHMRC Health Professional Research Early Career Fellow
The University of SydneyFaculty of Medicine and Health, Sydney School of Public Health

Dr Stephanie Mathieson is a Research Fellow at the Institute for Musculoskeletal Health, The University of Sydney. Her National Health and Medical Research Council (NHMRC) Health Professional Research Early Career Fellow is focused around reducing the opioid epidemic in Australia.

Dr. MATHIESON  What is the background for this study?

Response: This study aimed to review the current evidence of the efficacy of interventions designed to reduce/cease the prescription of, or the use of, opioid analgesics in patients with chronic non-cancer pain.

As clinical practice guidelines now discourage the initial prescription of opioid analgesics for chronic non-cancer pain, clinicians need to know which opioid dose reduction methods are most effective and safe for deprescribing opioid analgesics in their patients.  What are the main findings?

Response: Our systematic review extended the previous body of literature by incorporating five new randomised trials; however, clinical and statistical heterogeneity prevented meta-analysis. There were ten patient-focused interventions (i.e. aimed at reducing a patient’s opioid dose), and two clinician focused interventions (i.e. aimed at changing the clinician’s behaviour). Overall, our review was unable to recommend any one opioid analgesic deprescribing strategy in patients with chronic pain due to the small number of trials and heterogeneity.

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Study Finds Patients Feel Empowered By Interventions for Pain Relief Interview with:

Johan Hambraeus, MD
Board certified in anesthesiology, family medicine & Pain management
Department of Epidemiology and Global Health
Umeå University, Sweden  What is the background for this study?

Response: When working with interventional pain management a striking feature is that all procedures are painful. It is often discussed about sedation before procedures, but whether to provide sedation seems to be more based on the local tradition than on facts. And it is not seldom that patients describe that they have phobic fear of needles, but despite this they cope with the interventional pain management and all the painful procedures.

Therefore we wanted to understand how it is felt and how the patients describe their experiences.

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Pain Relief Patch Significantly Reduced Moderate to Severe Chronic Pain Interview with:
Peter Hurwitz
Clarity Science, LLC

Clarity Science Logo. (PRNewsFoto/Clarity Science)  What is the background for this study?

Response: Over the past several years, there has been a big push from healthcare professionals and patients to identify alternative pain management treatments and multimodal approaches that have been shown to have minimal side effects for those who experience mild to moderate and chronic pain conditions. These strategies may include non-pharmacological and pharmacological therapies. Topical therapies have been shown to address various pain conditions with minimal side effects as compared to oral over-the-counter (OTC) agents, prescription NSAIDs, and prescription opioids. T

his IRB-approved study evaluated whether a topical analgesic pain-relieving patch containing methyl salicylate (10%), Menthol (6%) and Camphor (3.1%) could reduce pain severity and improve function in patients over the course of 14 days.

Which Older Adults Use Cannabis for Chronic Pain Relief? Interview with:
Julie Bobitt, PhD

Director, Interdisciplinary Health Sciences
University of Illinois at Urbana Champaign
Champaign, IL. 61820

Dr. Julie Bobitt
Dr. Julie Bobitt  What is the background for this study?

Response: Our previous research found that older adults, who we interviewed, used cannabis primarily for pain related reasons and that they were reporting using cannabis to reduce or altogether stop their use of opioids.  We wanted to further study this and we wanted to see if there were any differences between self-reported pain in non-cannabis users vs. cannabis users and then if there were differences between groups who used cannabis alone versus those who used opioids alone, versus cannabis in combination with opioids. 

Ethos Develops Biomarkers to Personalize Chronic Pain Relief Interview with:

Brian Kincaid
Chief Executive Officer of Ethos Laboratories

How can reducing healthcare costs be achieved by the identification and validation of biomarkers through diagnosis and treatment of chronic pain?

Response:  Medicine has been evolving over the past couple of decades with a shift to personalized or targeted medicine.  As technology has improved and equipment capabilities have increased, the ability to identify and measure biomarkers is more affordable and accessible than ever before. Physicians now have access to more information specific to each individual patient, and as a result, can personalize treatment for each patient. 

Chronic pain is a very difficult disease for physicians to treat. The majority of assessments used by the physician are subjective in nature and rely heavily on accurate information provided by the patient, which can lead to unnecessary treatments. By adding an objective measurement as part of the chronic pain assessment, unnecessary treatments can be avoided and targeted treatments can be pursued. By reducing the number of unnecessary treatments, not only does the cost of care for the patient go down, but the quality of the care is improved. 

Using objective biomarkers as part of the chronic pain assessment will also provide some information on the viability of prescribing opioids at that time. Opioids will not help improve a patient’s biochemistry, and in some cases, opioids can have a negative effect on biochemistry. By treating abnormal biochemistry with safe inexpensive options first, it may be possible to avoid long term opioid prescribing for some patients, which would eliminate the costs associated with opioids in that patient subset.

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Osteoarthritis: Review of Medications for Long Term Pain Control Interview with:
Dr. RovatiLucio Rovati, M.D.
Department of Medicine and Surgery
School of Medicine
Monza – Italy What is the background for this study?  

Response: This is the first meta-analysis in osteoarthritis (OA) that takes into account only long-term (defined as at least 12-month duration) clinical trials. In addition, this is a network meta-analysis, i.e. we could take into account virtually all available medications and all experimental pharmacological treatments with published studies.

Analysis of long-term data is particularly important because OA is a chronic and progressive disease, but most medications are studied mainly for their short-term effects, i.e. mostly up to 3-6 months only. This creates troubles when physicians have to perform a chronic management of their patients. Continue reading

Gene Responsible for Sensing Mechanical Pain Identified Interview with:
Reza Sharif Naeini, Ph.D.
Associate Professor
Department of Physiology & Cell Information Systems Group
McGill University
Life Sciences Complex (Bellini),
Montréal, Québec  What is the background for this study?

Response: My lab is interested in understanding how our bodies detect signals from the environment, like our sense of touch and pain. This process is done by specialized sensors we have that detect mechanical stimuli, ranging from a hair deflecting under the wind, a gentle stroke, or a pinch. These sensors are called mechanosensitive ion channels and they convert mechanical forces into electrical signals that our nervous system can understand.

Their existence was first proposed in 1950 (to my knowledge) by Bernard Katz, and in 1999, researchers at the University of California in San Francisco, led by Dr. Jon Levine, demonstrated that pain-sensing neurons (termed nociceptors) express these channels. But their molecular identity remained elusive.

In 2010, the group of Dr. Ardem Patapoutian discovered the genes Piezo1 and Piezo2, with the latter being essential for our sense of touch and proprioception. While these findings were transformative to the field of somatosensation, mice lacking these genes were still able to respond to painful mechanical stimuli.

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What Drugs Are Prescribed for Chronic Musculoskeletal Pain Relief? Interview with:
Debbie Feldman
,, Ph.D.
Professeure titulaire/Full Professor
Faculté de médecine/Faculty of Medicine
École de réadaptation/School of Rehabilitation
Université de Montréal

Debbie Feldman,, Ph.D.
 Professeure titulaire/Full Professor
 Faculté de médecine/Faculty of Medicine
 École de réadaptation/School of Rehabilitation
 Université de Montréal
Dr. Feldman  What is the background for this study?  What are the main findings?

Response: The goal was to explore clinical management of new cases of musculoskeletal conditions associated with chronic pain, at the population level. Few studies to date have addressed treatment at the population level and none explored initial management specifically. Furthermore, not much is known regarding patient and provider characteristics that are potentially associated with different treatment options (except for some information regarding prescription of opioids). Main findings are in the answer below.

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