Category Archives: Chronic Pain

Study Addresses How Weather Affects Pain Tolerance

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PainRelief.com Interview with:
Erlend Hoftun Farbu, PhD student
Department of Community Medicine
The Arctic University of Norway
Tromsø, Norway

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

Response: Many report that weather affect their pain condition. Some studies confirm this, others do no. However, these studies have asked “How much pain do you have today?”

We used two tests to assess how much pain a person can tolerate. We then looked at how pain tolerance vary over time and if they are associated with weather.

The results show quite clearly that people can tolerate more pain caused by intense cold temperature in the colder months of the year. There was no such seasonal variation in pain caused by pressure to the leg. On the other hand, we found that both pressure pain tolerance and weather at one day was associated with the next days, but not the next month. When we further linked the weather and pain tolerance, we found that, for example, in some periods a rise in temperature happened at the same time as a rise in pain tolerance. While in other periods, there were no such association. We mean that this is because we adapt to the weather. For example, how we experience 5 °C (41°F) is different in autumn and spring..

Finally, temperature and barometric pressure could predict future values of pressure pain tolerance

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Switching to Buprenorphine Might Provide Pain Relief for Poorly Controlled Pain

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PainRelief.com Interview with:
Victoria D. Powell, MD, FACP
Clinical Lecturer – Geriatric and Palliative Medicine
University of Michigan
Staff Physician, Palliative Care
LTC Charles S. Kettles VA Medical Center
Ann Arbor, MI

Dr. Powell

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

Response: People with chronic pain who use long-term opioids face a number of health risks, and often do not have optimally controlled pain.

Buprenorphine acts on the opioid receptor with a different effect than drugs like morphine or oxycodone, and as a result is less associated with the risks of long-term opioid use, such as accidental overdose. While buprenorphine has been successfully used in patients with opioid use disorder for several years, certain experts have proposed using buprenorphine for pain management in people with chronic pain. We found low quality evidence supporting pain control that may be superior to traditional opioids, but much more research is needed to confirm.

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Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

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PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

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

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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Synovial Stem Cells Injected into Knee Repaired Meniscus without Tumor Formation

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PainRelief.com Interview with:
Mitsuru Mizuno, DVM, Ph.D.
Assistant professor at CSCRM,
Principal investigator for this study
and Ichiro Sekiya, M.D., Ph.D..

PainRelief.com:  What is the background for this study?  What are the main findings? How are the stem cells obtained?

Response: We have developed a cell therapy for treating difficult-to-heal meniscus injury using mesenchymal stem cells (MSCs) derived from the synovium of the knee. However, trisomy 7 is often found in synovial cells obtained from patients with osteoarthritis, a disease that occurs with aging.

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Pain in U.S. Adult Hispanics Varies by Their Ancestral Country of Origin

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PainRelief.com Interview with:
Richard L. Nahin, Ph.D., M.P.H
Lead Epidemiologist
National Center for Complementary and Integrative Health (NCCIH)
National Institutes of Health
Bethesda, Maryland

Dr. Nahin

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

Response: Individuals of Hispanic ancestry living in the U.S. include numerous subpopulations that vary in the prevalence of chronic disabling conditions, as well as exhibit differences in socioeconomic status, health behaviors, global health status, health care utilization, and genetic profiles. 

Despite this evidence, there are few nationally representative studies examining the epidemiology of pain in these Hispanic subpopulations, and none that compared global measures of pain chronicity, severity, nor examined the influence of race on potential associations with pain in Hispanics.

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Chronic Pain Increasing in Every Age and Demographic Group

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PainRelief.com Interview with:
Hanna Grol-Prokopczyk PhD
Associate Professor
Department of Sociology
University at Buffalo, SUNY

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

Response: Although chronic pain is recognized as an extremely common and costly health problem, little research has explored temporal trends in pain prevalence.  Indeed, as recently as 5-6 years ago, there was no published research using general population data examining whether pain prevalence in the U.S. was going up, going down, or staying constant.  (This can be contrasted to conditions such as diabetes and cancer, for which information about long-term trends is readily available.  Of note, chronic pain affects more Americans than diabetes, cancer, and heart disease combined.)  In recent years, a few studies have documented rising pain prevalence in the U.S., but most have used data on middle-aged or older adults.

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Tapentadol Provided Pain Relief and Improved Sleep in Patients with Chronic Musculoskeletal Pain

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PainRelief.com Interview with:
Dr Renato Vellucci
Contract Professor University of Florence
Pain and Palliative care Clinic
University Hospital of Careggi
Florence, Italy

Dr. Vellucci

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

Response: Chronic low back pain (CLBP) is the most prevalent chronic pain (CP) condition and the leading global cause of years lived with disability. According to the axiom pain as a biopsychosocial issue, mood and sleep disturbances represent key issues. However, the impact of different analgesic therapies on quality of life (QoL) and functional recovery has been poorly assessed to date. Focusing on combination of chronic pain and sleep, they both perform a mutual reinforcement.

Pain disorganizes the sleep architecture, and disturbed and unrefreshed sleep increases spontaneous pain and lowers pain thresholds. Sleep disorders may augment stress levels, thus making it difficult for patients to perform simple tasks impairing their cognitive ability. Poor sleep may predict the growth and intensification of pain over time, with increased insomnia symptoms being both a predictor and an indicator of worse pain outcomes and physical functioning status over time. Epidemiology of chronic pain unequivocally demonstrates the role of sleep quality in the development of chronic pain.

Notwithstanding this strong two-way relationship between chronic pain and sleep, little knowledge is available about the neurochemical determinants of this interplay and therapeutical strategies to break this vicious circle. Fifty percent of people with chronic low back pain have sleeping disturbances, with an 18-fold increase in insomnia versus healthy people. A recent study investigated the relationship between sleep disturbances and back pain and found that it is two sided with sleep disturbance being associated with risk of back pain whilst back pain can also lead to sleep disturbances. Thus, it can be hypothesized that, by reducing pain and physical dysfunction, sleep quality could be improved, thus enriching the QoL of people with CLBP.

Similarly, improvements in sleep after cognitive behavioral therapy in patients with chronic pain due to osteoarthritis were associated with reduced pain. Earlier evidence suggested that tapentadol prolonged-release treatment ameliorate in parallel QoL and sleep quality in a greater proportion of patients compared to that of patients following oxycodone/naloxone prolonged- release treatment (50% versus 37.7%). Other tapentadol studies conducted in a real-life context documented, along with effective pain control, similar improvements in mental and physical health and suggested beneficial effects in terms of less night awakenings and greater percentages of patients reporting restful sleep.

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Opioid Analgesic Use For Pain Relief in Chronic Noncancer Pain

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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

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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.

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

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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.

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