Mass General Study Evaluates AI Models of Pain Management For Racial, Ethnic or Sex Bias

PainRelief.com Interview with:
Marc D. Succi, MD
Strategic Innovation Leader | Mass General Brigham Innovation
Associate Chair of Innovation & Commercialization | Mass General Brigham Enterprise Radiology
Co-Director, Innovator Growth Division, Mass General Brigham Innovation
Attending Radiologist | Mass General Emergency Radiology 
Assistant Professor of Radiology | Harvard Medical School
Executive Director, Mass General Brigham MESH Incubator

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

Response: This study investigates whether large language models (LLMs), such as GPT-4 and Google’s Gemini, introduce racial, ethnic, or sex-based bias when recommending opioid treatments for pain management. Existing literature highlights racial disparities in pain treatment, with Black patients often receiving less aggressive pain management compared to White patients.

LLMs, as AI tools trained on large datasets, may either perpetuate these biases or help standardize treatment across diverse patient groups. This study analyzed hundreds of real-world patient cases, representing various pain conditions, to assess if race, ethnicity, or sex influenced the LLMs’ opioid treatment recommendations.

Mindfulness-Based Interventions Delivered via Telehealth Improved Pain and Well-Being Among People with Chronic Pain

PainRelief.com Interview with:
Diana Burgess, PhD
Director of the VA Advanced Fellowship Program in Health Services Research
CCDOR: Center for Care Delivery and Outcomes Research
Director of the VA QUERI Complementary and Integrative Health Evaluation Center (CIHEC)
Professor of Medicine at the University of Minnesota

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

Response: Mindfulness is being aware and paying attention in a kind, non-judgmental way, to what is happening in the present moment. Mindfulness-based interventions teach people mindfulness skills, through a variety of practices, such as meditation and mindful movement. Although mindfulness interventions are evidence-based treatment for chronic pain and conditions that often accompany pain, like anxiety and depression, many MBIs are difficult to implement at scale in healthcare systems as they require trained mindfulness instructors, dedicated space and pose barriers to patients due to the time commitment involved. We wanted to develop MBIs that were relatively low resource, scalable and more accessible for patients. 

Study Finds Sex Bias in Pain Management in Emergency Departments

PainRelief.com Interview with:
Mika Guzikevits
Doctoral Student
Prof. Choshen-Hillel’s Decision-Making lab
School of Business Administration & Federmann Center for the Study of Rationality 
The Hebrew University of Jerusalem

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

Response: Although pain is one of the most common reasons for seeking medical help, providing adequate treatment can be challenging due to its subjective nature. When healthcare providers’ pain management decisions rely on subjective judgment, they are susceptible to biases.

PainRelief.com: What are the main findings?

Response: Our study, which analyzed over 21,000 patient records from the United States and Israel, found a significant sex bias in pain management at emergency departments. We found that female patients are consistently less likely to receive pain relief prescriptions compared to male patients with similar complaints (around 10% difference). This bias persists across different ages, pain levels, and physician sex, indicating a systemic issue. Female patients’ pain scores are less frequently recorded, and they spend more time in the emergency department than male patients. In a controlled experiment involving 109 nurses, we found that pain was rated as less intense if the patient was said to be female rather than male, which supports our hypothesis that healthcare providers are susceptible to stereotypical beliefs about women’s pain and expect them to act “hysterically” and exaggerate their pain reports.

UNC Scientists Identify Specific Brain Circuits Mediating Placebo Pain Relief

PainRelief.com Interview with:
Grégory Scherrer, PharmD, PhD
University of North Carolina at Chapel Hill
Depts of Cell Biology and Physiology, of Pharmacology
UNC Neuroscience Center

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

Response: The placebo effect is a fascinating phenomenon where a person’s positive expectations can lead to real changes in their physical or psychological state, even without active treatment. A specific aspect of this phenomenon is placebo analgesia, where the expectation of pain relief results in an actual reduction in pain perception. Placebo analgesia demonstrates the intricate power of the human brain that can be harnessed for pain control. However, despite extensive research, the neural mechanisms underlying placebo analgesia remain largely unclear.

Our study aimed to explore the neural circuits mediating placebo analgesia, using an innovative mouse model to mimic the human placebo analgesia. By doing so, we hoped to uncover how certain brain regions interact to produce pain relief through expectation alone, potentially opening new avenues for pain control by manipulating these circuits.

Experimental “bitopic” Opioid Suppresses Pain With Fewer Side Effects

PainRelief.com Interview with:

Susruta Majumdar, PhD
Professor in the Department of Anesthesiology
Washington University School of Medicine
Nokomis Ramos-Gonzalez, PhD
Postdoctoral Trainee in the Majumdar Lab
Washington University School of Medicine
Balazs R. Varga PhD
Center for Clinical Pharmacology
University of Health Sciences & Pharmacy at St. Louis
Department of Anesthesiology and Washington University Pain Center
Washington University School of Medicine
St. Louis, Missouri 63110

Jay McLaughlin, Ph.D
Professor of Pharmacodynamics
College of Pharmacy
University of Florida

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

Response:    Opioid medications tap into the body’s natural system for mitigating pain by activating pain-suppressing opioid receptors on neurons. Although meant to help, sometimes these medications do harm.  Opioid medications offer people relief from debilitating pain, but these drugs come with dangers: the risk for addiction, miserable withdrawal symptoms and the potential for fatal overdose.  New mechanistic insights into the function and regulation of the opioid receptors present the opportunity to design new, safer opioid painkillers. The team’s previous research utilized a strategy to design functionally selective “bitopic” opioids by targeting the sodium binding allosteric site in the opioid receptor.

CMAJ Study Suggests Clinicians Adapt Opioid Prescriptions to Specific Types of Acute Pain

PainRelief.com Interview with:
Raoul Daoust MD CSPQ MSc
Professeur titulaire/ full professor
Département Médecine de Famille et Médecine d’Urgence
Université de Montréal
Clinicien chercheur / Clinician Researcher
Médecine d’Urgence / Emergency Medicine
CEMU-HSCM (Centre d’Étude en Médecine d’Urgence)
SCEM-HSCM (Study Center in Emergency Medicine)
Hôpital Sacré-Coeur de Montréal
CIUSSS Nord-de-l’ile

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

Response: Overprescribing is linked to opioid misuse and overdose, with household supplies of opioids associated with an increased risk of overdose as many people do not dispose of unused medications safely. In Canada, more than 7570 people died of opioid overdoses in 2021, and more than 68 000 people died in the United States in 2020 from these same drugs.

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Chronic Pain Conditions Among Women in the Military Health System

PainRelief.com Interview with:
Andrew J. Schoenfeld, MD
Professor, Harvard Medical School
Orthopaedic Surgery
Brigham and Women’s Hospital 

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

Response: The impetus for this research stems from my time as the Director of the Medical Evaluation Board at Fort Bliss Texas during my time on active duty with the Army between 2009-13 and my time in Ann Arbor VA between 2013-15.  We wanted to understand the impact that repeated exposure to the high intensity deployment to combat theaters during 2006-2013  had on women active duty servicemembers and women civilian dependents of active duty servicemembers who were deploying

PainRelief.com: What are the main findings?

Response: Significant increases in the diagnosis of Chronic Pain conditions among women active duty service members as well as women civilian dependents who were affiliated with the military between 2006-13.

WalkBack Trial: Simple Exercise Strategy plus Education Can Help Prevent Recurrence of Low Back Pain

PainRelief.com Interview with:
Natasha C Pocovi
Department of Health Sciences
Macquarie University, Sydney
NSW, Australia

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

Response: Approximately 620 million people globally, reported suffering low back pain in 2020. While it’s not considered a life-threatening disease, we can see the very serious impacts it can have on people’s lifestyle, ability to work, and overall quality of life. While much work is being done to treat low back pain, ‘prevention’ is mostly unchartered territory. This is particularly important given the high rates of recurrent low back pain, where 7 in 10 people who recover from an episode of low back pain will have a new episode in the next 12 months.

A small number of studies have examined exercise to prevent the recurrence of low back pain. These have primarily focused on group-based, complex exercises focusing on a combination of strengthening and improving the endurance and flexibility of the spine. Some of these were delivered over several supervised sessions, some as many as 20 x 1-hour sessions. This becomes less feasible for patients to engage in.

Chronic Pain Improved in TBI Patients Receiving Collaborative Care

PainRelief.com Interview with:
Jeanne M. Hoffman, PhD, ABP
Professor, Department of Rehabilitation Medicine
University of Washington School of Medicine  

dr_jeanne_m_hoffman

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

Response: We were interested in finding a way to improve the treatment of pain for individuals with traumatic brain injury who often struggle with chronic pain, but may not always be able to benefit from the therapies that are available. 

PainRelief.com: What are the main findings?

Response: We found that using an approach called “collaborative care”, which is an integrated, team-driven approach to delivering patient-centered evidenced based care that, in our study, included 12 sessions of cognitive behavioral treatment of pain, led to improvements in pain interference at the end of treatment, which lasted an additional 4 months after treatment ended. 

We also found improvements in pain intensity after treatment as well as reductions in the collaborative care group in symptoms of anxiety and depression and increases in satisfaction with care.

EULAR 2024: Non-Articular Pain Common in Patients with Rheumatoid Arthritis

PainRelief.com Interview with:

Charis F. Meng, MD
Rheumatologist, Inflammatory Arthritis Center
Assistant Attending Physician
Hospital for Special Surgery
Assistant Professor of Clinical Medicine
Weill Cornell Medical College

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

Response: Non-articular pain (NAP) is common in our patients with rheumatoid arthritis (RA) and may impact remission outcomes.  However, it is challenging for busy rheumatologists to address specific pain types in our patients with RA, as it is not well defined in the literature, nor has it been validated in RA.  NAP in RA care thus is an unmet need for both our patients with RA and rheumatologists caring for them. 

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