Opioids Frequently Prescribed For Headache Pain Relief

PainRelief.com Interview with:
Richard B. Lipton, M.D.
Professor, The Saul R. Korey Department of Neurology
Professor, Department of Psychiatry and Behavioral Sciences
Professor, Department of Epidemiology & Population Health
Edwin S. Lowe Chair in Neurology
Vice Chair The Saul R. Korey Department of Neurology
Director, Montefiore Headache Center
Albert Einstein College of Medicine

PainRelief.com:  What is the background for this study

Response: Almost everyone with migraine takes acute treatments at the time of attacks to relieve pain and restore function.  Acute treatments include over-the-counter medications. prescription drugs and devices.  The most widely used prescription drugs for migraine are triptans (such as sumatriptan and rizatriptan) and NSAIDs (such as ibuprofen and naproxen). 

Richard B. Lipton, M.D. Professor, The Saul R. Korey Department of Neurology Professor, Department of Psychiatry and Behavioral Sciences Professor, Department of Epidemiology & Population Health Edwin S. Lowe Chair in Neurology Vice Chair The Saul R. Korey Department of Neurology Director, Montefiore Headache Center Albert Einstein College of Medicine
Dr. Lipton

Opioids are not recommended in treatment guidelines as acute treatments for migraine.  Longitudinal studies show that in people with migraine treatment with opioids is associated with dose dependent acceleration of headache frequency and the development of chronic migraine in people with episodic migraine.  The purpose of this study was to determine the relative frequency of opioid use and the characteristics of those who use opioids to treat migraine. The hope is to use this information to develop programs which will encourage guideline compliant treatment.

Targeting Specific Inflammatory Cells May Offer Enhanced Pain Relief

PainRelief.com Interview with:
Prof. Dr. Halina Machelska
Department of Experimental Anesthesiology
Charité-Universitätsmedizin Berlin
Berlin, Germany

Prof. Dr. Halina Machelska
Department of Experimental Anesthesiology
Charité-Universitätsmedizin Berlin
Berlin, Germany

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

Response: Pathological pain such as pain resulting from nerve injury is often accompanied by inflammation. This is manifested by accumulation of immune cells, including macrophages, in the damaged tissue. Current research mostly emphasizes the role of these cells in the enhancement of pain. One of the suggested strategies in the basic research is to deplete immune cells from the affected tissue. However, several previous preclinical studies, including our own, have shown that this approach did not sufficiently decrease pain. We think that one of the reasons is that not all immune cells invading damaged tissue are detrimental and in fact, some are needed there to counteract pain.

Macrophages are very heterogeneous and they comprise at least two subpopulations, pro-inflammatory M1 and anti-inflammatory M2 macrophages. Our idea in this study was to promote the analgesic properties of macrophages. We took advantage of the cytokine interleukin-4 (IL-4) to switch macrophages from the M1 to the M2 state.

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Safety And Efficacy Of The Unique Opioid Buprenorphine For Chronic Pain Relief

PainRelief.com Interview with:
Joseph V. Pergolizzi, Jr., M.D.

Co-Founder and Chief Operating OfficerNEMA Research Inc.

Joseph V. Pergolizzi, Jr., M.D.
 Co-Founder and Chief Operating OfficerNEMA Research Inc.

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

Response: Chronic low back pain (CLBP) is a leading cause of disability.

  • Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
  • Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
  • Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
  • Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
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Older Adults More Likely to Misuse Opioids for Pain Relief

PainRelief.com Interview with:

Ty S. Schepis, PhD
Department of Psychology
Texas State University
San Marcos, TX

Ty S. Schepis, PhD
 Department of Psychology
 Texas State University
 San Marcos, TX
Dr. Schepis

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

Response: Prescription opioid misuse motives have been studied in adolescents, young adults, and across the population. One study across the population suggested that older adults differed from younger adults, but this was not fully clear.

We wanted to examine motives across age groups and to investigate the correlates of opioid motive groups in older adults (50 and older). We found that motives changed with aging, with increasing endorsement of pain relief motives, particularly pain relief without other motives.

In contrast, more recreational opioid misuse motives (e.g., to experiment, to get high) peaked in adolescents or young adults. Finally, non-pain relief motives in older adults (50 and older) were associated with higher rates of any past year substance use disorder and past year suicidal ideation.

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Adults 50+ More Likely to Misuse Opioids for Pain Relief

PainRelief.com Interview with:
Ty S. Schepis, Ph.D.

Associate Professor
Department of Psychology
Texas State University

 Ty S. Schepis, Ph.D.
 Associate Professor
 Department of Psychology
 Texas State University

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

Response: We were interested in examining the underlying reasons for prescription opioid misuse both across the population and in older adults specifically. Given that pain conditions and physical health limitations increase with aging, we wondered if different age groups would display different patterns of motives. Indeed, they did. Adults 50 and older were particularly likely to misuse opioid medication only for pain relief reasons (over 80%); in contrast, roughly 65% of young adults (18-25 years) endorsed only non-pain relief motives for misuse.

For older adults, opioid misuse involving any non-pain relief motives was associated with a greater rate of also having another substance use disorder and past-year suicidal thoughts.

No Current Credible Evidence Cannabis Use is Helpful in Opioid Addiction

PainRelief.com Interview with:

Dr. Zena Samaan , MBChB, MSc, DMMD, MRCPsych (UK), PhD
Associate Professor
Program Director
Clinician Investigator Program
Faculty of Health Sciences
Department of Psychiatry
   Dr. Zena Samaan , MBChB, MSc, DMMD, MRCPsych  (UK), PhD

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

Response: The study background: the interest in cannabis use as a replacement for opioid use was sparked by reports suggesting that cannabis is a safer alternative and the public perception of cannabis as the answer for many health problems is growingly fueling the debate on the potential use of cannabis to help in the opioid crisis. Reports from USA for example in 2014 using administrative data suggested that in States were there is medical cannabis law, the rate of death attributed to opioids was lower, generating wide media attention. Since then however an updated study using the same data published in 2019 showed that when the data were re-analyzed and the time frame was extended, the opposite was seen, in that states with cannabis law had higher opioid related mortality.

Our study came form the observations that patients with opioid use disorder are commonly using cannabis (~50% of patients used cannabis while on treatment for opioid addiction) and given the recent public interest, our goal was to provide evidence informed conclusions on the potential effects of cannabis on opioid use in patients with opioid addiction.

Opioids Commonly Prescribed for Pain Relief from Osteoarthritis

PainRelief.com Interview with:

Dr. Jonas Bloch Thorlund  MSc, PhD
Professor of Musculoskeletal Health
Department of Sports Science and Clinical Biomechanics &
Research Unit for General Practice (Dept. of Public Health) 
Dr. Thorlund

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

Response: Opioids are commonly prescribed to patients with knee and hip osteoarthritis (OA). But for newly diagnosed patients’ clinical guidelines recommend exercise therapy, patient education and weight loss (if needed) as first line treatment. These treatments can be supplemented or replaced with biomechanical interventions (insoles, wedges, cane use, etc.), and paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) if needed. Generally, opioids are should only be used when other treatment options are exhausted, ineffective or contraindicated. Thus, treatment with opioids shortly after OA diagnosis is considered inappropriate according to guidelines.

Knee Osteoarthritis: Orthopedists Prescribing More NSAIDS and Less Lifestyle Management for Pain Relief

PainRelief.com Interview with:

Samannaaz Khoja, PT, PhD
Research Assistant Professor
Department of Physical Therapy
University of Pittsburgh School of Health and Rehabilitation Sciences

Samannaaz Khoja, PT, PhD Research Assistant Professor Department of Physical Therapy University of Pittsburgh School of Health and Rehabilitation Sciences
Dr. Khoja

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

ResponseThe purpose of this study was to describe and compare rates of physicians’ recommendation for physical therapy (PT), lifestyle-counseling, and pain medication for knee osteoarthritis (KOA) between 2007 and 2015. The study also aimed to identify patient, physician and practice-level factors associated with each treatment recommendation.   We used survey data from the National Ambulatory Medical Care Survey, data from this survey is publicly available and is housed within the CDC. We identified 2297 knee OA related visits, which approximated to 67 (±4) million weighted physician visits between 2007 and 2015 (around 8 million visits/year).

Do Men and Women Have Different Pain Relief Response to Opioids?

PainRelief.com Interview with:
Roberta Agabio, M.D.
Dpt. Biomedical Sciences
University of Cagliari
Cittadella Universitaria Monserrato
Monserrato (CA) – ITALY

PainRelief.com:  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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Who Teaches Faculty to Educate Medical Residents About Opioids for Chronic Pain?

PainRelief.com Interview with:

Payel Roy, MD
Section of General Internal Medicine
Department of Medicine
Boston University School of Medicine and Boston Medical Center
Boston, Massachusetts.

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

Response: Given the current opioid crisis, we know how important it is to educate physicians-in-training in safer opioid prescribing.  But we can’t educate them properly if their faculty mentors don’t feel comfortable prescribing opioids themselves.  Our study evaluated a program designed to improve faculty physicians’ comfort in prescribing opioids safely and teaching these practices to trainee physicians.  

We found that faculty development programs can improve their confidence in prescribing opioids safely and teaching their trainees about prescribing, however translating these attitudes into teaching practice remains a challenge.