Self-Reported Prescription Drug Use for Pain Relief and Sleep Linked to Frailty. Interview with:
Andrew W Bergen, PhD
Senior Scientist
Oregon Research Institute
Eugene, OR 97403

Dr. Bergen  What is the background for this study?

Response: The background to the study is examination of the incident frailty risks of two classes of prescription drugs commonly co-prescribed in response to pain and sleep indications.

The dataset consisted of N=7,201 non-frail, age 65+, community-living individuals from the Health and Retirement Study, a nationally representative longitudinal cohort interviewed every two years.

The drug exposure measures are based on responses to the two questions: “Do you regularly take prescription medications for any of the following common health problems:

For pain in your joints or muscles?” and “Do you regularly take prescription medications for any of the following common health problems: To help you sleep?”.

The outcome measure was the Burden Model of frailty using the conventional threshold of >0.2 for frailty.

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Which Adolescents Can Get Pain Relief from Cognitive-Behavioral Therapy? Interview with:
Caitlin Murray, PhD
Research Fellow
Center for Child Health, Behavior and Development
Seattle Children’s Research Institute

Caitlin Murray, PhD  Research Fellow  Center for Child Health, Behavior and Development  Seattle Children’s Research Institute
Dr. Murray  What is the background for this study?

Response: We know that chronic pain is a significant problem among children and adolescents, and that cognitive-behavioral therapy (CBT) can be helpful. However, studies show that CBT doesn’t help every child or adolescent affected by chronic pain.

In this study, we explored what factors predicted adolescents’ response to internet-delivered CBT for chronic pain—that is, which factors made it more likely that adolescents would benefit from the CBT intervention. Our primary treatment outcome was pain-related disability, or the extent to which pain interfered with the adolescent’s daily activities.

We found that both adolescent age and parent emotional distress predicted treatment efficacy up to one year after treatment, such that adolescents who were younger and those whose parents expressed less distress were more likely to benefit from this form of cognitive-behavioral therapy.

Acupuncture for Chronic Musculoskeletal Pain Relief: A Review of Randomized Trial Interview with:
Chenchen Wang MD, MSc
Professor of Medicine
Tufts University School of Medicine
 Director, Center For Complementary And Integrative Medicine                                             
Division of Rheumatology
Tufts Medical Center, Boston, MA

Dr. Chenchen Wang
Dr. Chenchen Wang  What is the background for this study?  What are the main findings?

Response: Chronic Musculoskeletal Pain is a complex disorder without effective treatment Acupuncture, originating in China more than 3,000 years ago, is one of the most popular sensory stimulation therapies. However, despite the fact that acupuncture is widely used for pain relief in a number of conditions including severe knee osteoarthritis, acute postoperative pain, musculoskeletal disorders, evidence of the effect of Chronic Musculoskeletal Pain relief is scarce.

Our study was to determine the efficacy of acupuncture for pain relief in this field.

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Pain Medication Beliefs Can Enhance (or Impair) Pain Relief Interview with:
Leon Timmerman, PhD
St Antonius Hospital, Department of Anesthesiology
Intensive Care and Pain Medicine
The Netherlands

Leon Timmerman, PhD St Antonius Hospital, Department of Anesthesiology Intensive Care and Pain Medicine The Netherlands
Dr. Timmerman  What is the background for this study?  What are the main findings?

Response: Chronic pain is commonly treated with pain medication. However, the results of pharmacological treatment are often poor. One of the reasons might be that half of the patients do not use their medication as prescribed. Underuse as well as overuse are common and have been described to result in reduced treatment effect, health care risks and unnecessary treatment changes. The are many risks factors described for non-adherent behavior.

The way people think about their pain medication have been shown to be related to the way they use their medication. With this study, we confirmed this relation with a prospective study. Baseline beliefs about pain medication, measured by ‘Pain Medication Attitudes Questionnaire’,  were found to be related to underuse of pain medication, the occurrence of side effects and patient satisfaction after three months.  

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Over-the-counter Medical Device Offers Promise for Long Term Chronic Pain Relief

Ian Rawe Ph.D
BioElectronic Corporation
Frederick, MD
ActiPatch  What is the background for this study?

Response: The aim of this study was to investigate the long-term effectiveness of a neuromodulation medical device (ActiPatch®) in relieving chronic pain. The device is topically applied, paresthesia-free and uses high-frequency electromagnetic fields to mitigate nerve sensitization and provide pain relief. Identified as Pulsed Short Wave Therapy (PSWT), this technology is available over-the counter in many countries, including the US, Canada, EU and Australia.

While existing randomized, placebo controlled clinical trials demonstrated PSWT treatment effectiveness over several weeks, data on long-term effectiveness was unavailable. In this study, a sample of 240 chronic pain subjects, who reported clinically significant pain relief (reduction ≥ 2 VAS points) following a 7-day trial of the medical device, agreed to participate in a six-month study to investigate treatment durability. These subjects indicated an average chronic pain duration of 6.5 years, in multiple locations and from a wide spectrum of causes (etiologies). Moreover, these subjects reported that their existing pain management regimen (often multimodal therapy) provided inadequate relief, and that they experienced severe to moderate pain (≥ VAS of 8/10), daily.

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Non-Viral Gene Therapy Offers Hope for Pain Relief from Diabetic Neuropathy Interview with:  
Sheila Yi, Helixmith What is the background for this study? Would you explain how VM202 is unique?

  • ResponseDiabetic peripheral neuropathy is one of the most common complications of diabetes and many of DPN patients suffer from severe pain that affects their daily activities and life quality. Though there are medications, both Rx and OTC drugs, used to ameliorate pains from diabetic peripheral neuropathy, many of them fall short of analgesic efficacy or often lead to not so trivial side effects. 
  • Engensis (VM202) is plasmid DNA therapy, non-viral gene therapy, which encodes hepatocyte growth factor (HGF) gene that is designed to simultaneously express two isoforms of HGF protein at high levels. HGF is known to have angiogenic and neurotrophic effects and, when expressed in the human body, induces formation of new micro vessels and nerve regeneration through remyelination and axon outgrowth, resulting in improvement in peripheral neuropathy condition. Engensis does not integrate into the human genome.
  • Historically, our research first focused on therapeutic angiogenesis of HGF with a proof of concept research in critical limb ischemia, an extreme form of peripheral artery disease. In the process, we realized that Engensis would also be effective for peripheral neuropathy, and a coffee chat with the current PI, Dr. Kessler of Northwestern University, led to an idea of using Engensis in neurological diseases.
  • Throughout Phase 1 through 3 clinical trials for DPN in the US, Engensis has been observed safe and well-tolerated in patients, and, during the Phase 3 study, received RMAT (regenerative medicine advanced therapy) designation from the FDA.
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Do Men and Women Have Different Pain Relief Response to Opioids? Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY  What is the background for this study?

Response: Pain is the leading cause for seeking medical care worldwide, and opioids are the most frequently prescribed drugs for pain relief. Differences and similarities between men and women in both effectiveness and side effects to opioids used for pain relief have been described. In addition, individuals may respond differently to these medications for other reasons for example: the intensity of pain experienced, amount and type of administration of opioids (e.g. fixed doses established by physicians or flexible doses decided by patients), mental condition, age, body weight, and use of alcohol, tobacco and/or cannabis.

However, the role of these factors in influencing sex differences and similarities in the response to opioids used for pain control has not been thoroughly investigated.

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Chronic Back and Knee Pain Relief: How Do Sham Procedures Compare to Surgery? Interview with:

Wayne B Jonas MD

Wayne B Jonas MD

H&S Ventures
Samueli Integrative Health Programs  What is the background for this study?

Response: The findings of this study are based on a systematic review of 25 randomized clinical trials evaluating surgical type interventions (open surgeries, arthroscopic, endoscopic, laparoscopic, heart catheterization, radiofrequency, laser, and other interventions) for chronic back and knee pain. In each study, researchers had also performed sham procedures on a control group where they replicated the invasive procedure by omitting the step believed to be therapeutically necessary. The purpose of this it to determine how much of the effects are due to the placebo response.

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Self-Administered Acupressure Studied for Chronic Low Back Pain Relief Interview with:

Susan Murphy, Sc.D., O.T.R.
Associate Professor
Physical Medicine and Rehabilitation Department
Research Health Science Specialist
VA Ann Arbor Health Care System, GRECC  What is the background for this study?

Response: Chronic low back pain is very common and affects quality of life by reducing the ability to carry out needed and valued activities. In addition, people with chronic low back pain tend to have other symptoms like fatigue, sleep disturbances, and depression. Medications are typically prescribed but have side effects, and in some cases, may increase the risk of abuse and addiction. Non-pharmacological treatments are an important part of chronic pain management and may reduce pain as well as other symptoms.

In this study, we examined the use of self-administered acupressure as a pain management strategy in people with chronic low back pain. Acupressure is a Traditional Chinese Medicine technique in which physical pressure is applied to specific points on the body. It is similar to acupuncture, but instead of needles, pressure is applied with a finger, thumb, or device. In previous studies, people with cancer-related or osteoarthritis pain who self-applied acupressure had reduced symptoms such as pain and fatigue. What are the main findings?

Response: Our pilot randomized controlled trial involved 67 participants with chronic low back pain. They were randomized into one of three groups – relaxing acupressure, stimulating acupressure, or usual care. Participants in the acupressure groups were trained to apply pressure to specific anatomical points on their body, and asked to complete daily treatment sessions for 6 weeks. We found that people who performed stimulating acupressure had improved pain and fatigue, and people who performed relaxing acupressure had improved pain after 6 weeks compared to those in the usual care group. No differences among the groups were found for sleep quality or disability after 6 weeks. Participants performed an average of 85% of the daily acupressure sessions and there were minimal adverse events. Adverse events, such as skin breakdown, muscle spasm, and headache were attributed to applying too much pressure and adjustments in application technique was done to avoid future issues. What should readers take away from your report?

Response: Self-administered acupressure shows some promising effects on pain and fatigue in people with chronic low back pain. It is a low cost and low risk symptom management strategy that people can adhere to. What recommendations do you have for future research as a result of this work?

Response: Because this was only a pilot study, larger studies are needed to support the effectiveness of this treatment for people with chronic low back pain.


Susan Lynn Murphy, Richard Edmund Harris, Nahid Roonizi Keshavarzi, Suzanna Maria Zick, Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial, Pain Medicine, , pnz138,

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Osteoarthritis: Poor Sleep Linked to More Pain Interview with:
Dr. Daniel Whibley PhD
Department of Physical Medicine and Rehabilitation
University of Michigan, Ann Arbor, Michigan
Epidemiology Group, School of Medicine, Medical Sciences and Nutrition
University of Aberdeen, Scotland, UK  What is the background for this study?  What are the main findings?

Response: Older adults with osteoarthritis commonly report symptoms of pain, fatigue and poor sleep quality. Previous research has investigated how this symptoms are cross-sectionally and longitudinally associated with each other. However, no previous studies have investigated how the quality of a night’s sleep impacts on the next day’s course of pain and fatigue in this clinical population.

We found that poor sleep quality was associated with greater pain intensity and fatigue on awakening when compared to a good night’s sleep and that, over the course of the day, the effects were sustained. Although a night of better quality sleep was associated with less pain and fatigue on awakening,  these symptoms worsened more rapidly throughout the day, such that as the day progressed the effect of the previous night’s sleep became less and less important.

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