Long Covid Symptoms Common, Especially Taste and Smell Issues

PainRelief.com Interview with:
Elizabeth K. Rutkowski, MD MS
Associate Professor of Neurology
Director, Neurology Clerkship
Assistant Director, Adult Neurology Residency Program
Medical College of Georgia
Augusta University Medical Center

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

Response We are looking at the long-term neurological effects of COVID-19. 80% of our subjects reported neurological symptoms with the most commonly reported symptoms being fatigue and headache.

Continue reading

Headache: Clinical Trial Finds Oral Atogepant Reduced Monthly Migraine Days

Dr. Trugman

PainRelief.com Interview with:

Joel M. Trugman, MD
Associate Vice President
Neuroscience Development
AbbVie

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

Response: Migraine is a disabling chronic disease characterized by recurrent headache attacks and associated symptoms, including nausea, phonophobia, or sensitivity to sound, and photophobia, or sensitivity to light.

The ADVANCE clinical trial is a phase 3, randomized, double-blind, placebo-controlled trial and examined the safety and efficacy of atogepant, an oral, small-molecule calcitonin gene-related peptide receptor antagonist in patients with episodic migraine. The primary efficacy endpoint was the change from baseline in mean monthly migraine days (MMD) across the 12-week treatment period. This analysis that was recently published examined the efficacy of atogepant using 4 levels of mean monthly migraine day (MMD) responder rates. 

This analysis found that all doses of atogepant significantly increased the proportion of participants who achieved a ≥25%, ≥50%, ≥75% and 100% reduction in mean monthly migraine days over 12 weeks of treatment.

More Nonopioid Medications Prescribed for Pain Relief since CDC Released Chronic Pain Guidelines

PainRelief.com Interview with:

JASON GOLDSTICK
Dr. Goldstick

Jason E. Goldstick, PhD
Injury Prevention Center
Department of Emergency Medicine
University of Michigan, Ann Arbor

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

Response: In 2016, the CDC released the Guideline for Prescribing Opioids for Chronic Pain. A primary goal of this voluntary guideline is that individuals should receive pain management care that provides the greatest overall benefit. Among other things, this may entail beginning opioid treatment only when the clinician determines that the expected benefits outweigh the risks.

Other research has shown reductions in opioid prescribing as reduced since the guideline release; this report examines whether there were changes in nonopioid pain medication prescribing.

Our overall findings were that nonopioid prescribing increased nationally following the guideline release, above and beyond what would’ve been predicted based on the pre-guideline trends, and this finding was generally consistent across patient subpopulations (e.g., those with vs. without prior opioid exposure).

Continue reading

PTSD: Cognitive Behavioral Therapy for Pain Relief from PostTraumatic Headache

PainRelief.com Interview with:
Don McGeary, PhD, ABPP
Vice Chair for Research, Rehab Medicine
Associate Professor, Rehab and Psychiatry
UT Health San Antonio

Don McGeary
Dr. McGeary

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

Response: This was a randomized clinical trial funded as part of the Consortium to Alleviate PTSD.  The primary aim of the study was to test the efficacy of a novel non-pharmacological intervention (called CBT for headache; CBTH) for posttraumatic headache (PTH) attributable to mild traumatic brain injury (mTBI). 

PTH is the most common and disabling consequence of mild traumatic brain injury and is a large concern for military service members and veterans in the post-9/11 deployment era because of the significant increase in head injury in this population over the last 20 years.  Posttraumatic headache has been recognized under various labels (including “shell shock” and “hero’s headache”) for over a century, but there are no proven, frontline treatments for PTH. PTH is unique among headache diagnoses because it is classified as a secondary headache (i.e., develops as a consequence of another medical phenomenon, mTBI) and because it is diagnosed based on the injury that led to the headache with no criteria for specific clinical characteristics.  Thus, the “phenotype” of posttraumatic headache is variable with the most frequent reports describing symptoms consistent with migraine AND tension type headaches. 

Unfortunately, because the underlying mechanisms of PTH differ from the primary headaches they resemble, frontline medications (abortive and prophylactic) may not have the same efficacy for PTH as they do for the primary headaches for which they are usually prescribed.  To complicate things further, PTH is often acquired in the context of a traumatic experience (blast, firearms overpressure, motor vehicle accident, other traumatic injury), so PTSD is highly comorbid with these headaches and there is an evolving body of research showing that PTSD can complicate, maintain and worsen pain.

Thus, our study sought to
(1) Test a novel non-pharmacological intervention tailored to PTH rehabilitation and
(2) Assess the relationship between PTSD and PTH to determine if preferred treatment pathways should include PTSD treatment as well. 

This resulted in a three-arm trial comparing CBTH to a gold-standard non-pharmacological treatment for PTSD and usual care in a large VA polytrauma center.

Relivion Stimulator of Both Occipital and Trigeminal Nerves for Migraine Pain Relief

PainRelief.com Interview with:
Oved Daniel MD
Headache and Facial Pain Clinic
Ramat-Aviv Medical Center
President of the Israeli Headache Association
Tel-Aviv, Israel

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

Response: Migraine patients experience disabling symptoms, which often left untreated or exasperated by currently available therapies, therefore, a significant unmet medical need for treating migraine pain remains.

Current external nerve stimulation devices only target one nerve and this study assessed the safety and performance of a new external nerve stimulation device that stimulates the two major nerve branches associate with pain (occipital and trigeminal) .

The Relivion MG is a non-invasive device that the patient can wear at home to treat their migraine pain and associate symptoms.

Preclinical Trial Tests Combination of CBD:THC for Migraine Relief

PainRelief.com Interview with:
Andrew F. Russo, Ph.D.
Professor, Dept. Molecular Physiology and Biophysics
University of Iowa
Iowa City, IA 52242

Dr. Russo

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

Response: The company Schedule 1 Therapeutics approached us with an interest in testing a combination of CBD:THC in migraine. We thought the topic had tremendous public interest so we teamed up with them and won grants from the Migraine Research Foundation and from the National Institute on Drug Abuse.  

Experimental Hydrogel Improved Chronic Pain from Degenerative Disc Disease

PainRelief.com Interview with:
Douglas P. Beall, MD, FSIR
Chief of Radiology Services
Clinical Radiology of Oklahoma

Dr. Bealll

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

Response: Degenerative disc disease (DDD) is the leading cause of chronic low back pain and one of the world’s most common medical conditions contributing to high medical and disability costs. Healthy spinal discs act aids spine movement and distributes force which allows for spine flexibility and even distribution of the load that is placed on the spine. Each has a firm outer layer and a soft, jelly-like core. With normal aging, discs tend to become dry, thin, cracked or torn, which can cause pain and abnormal motion.

Substances called hydrogels, with biochemical similarities to the intervertebral disc designed to augment both the core and outer layer, have been used for years to help repair degenerated discs. First-generation hydrogels are placed as a soft solid, through a surgical incision, but were not simple to place and had a tendency to migrate from where they were originally placed.

For a first-in-human trial, our team conducted a prospective, single-arm feasibility study to evaluate an experimental, injectable hydrogel for safety and performance in relieving chronic low back pain caused by DDD. We used a second-generation hydrogel (Hydrafil™) developed by ReGelTec, Inc.. Unlike earlier hydrogels, it can be temporarily modified into a liquid and injected rather than placed through a small incision. In 2020, this product received FDA’s breakthrough device designation, allowing expedited review based on promising early evidence.

We recruited 20 patients, aged 22 to 69, who each described their pain as four or higher on a zero to 10 scale. None had found more than mild relief from non-surgical management, which includes rest, analgesics, physical therapy, and back braces. Patients were sedated for the procedure, and the gel was heated to become a thick liquid. Guided by fluoroscopic imaging, an interventional radiologist used a 17-gauge needle to inject the gel directly into the affected disc(s). The gel filled in cracks and tears and adhered to the disc’s core and outer layer.

Barriers to Implementation of Patient Education in Inflammatory Arthritis

PainRelief.com Interview with:
Mwidimi Ndosi PhD MSc BSc PGCert (Clin Ed) FHEA RN 
Sarah Bennet and Beth Jones
Associate Professor in Rheumatology Nursing
University of the West of England, Bristol  
Honorary Researcher
University Hospitals Bristol and Weston NHS Trust  

Dr. Ndosi

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

Response: Patient education is seen as an essential part of managing long-term conditions like inflammatory arthritis. Chronic inflammatory arthritis includes rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. We define patient education as a planned interactive learning process designed to support and enable people to manage their life with a disease and optimise their health and wellbeing.[1]

There are variations across Europe in the way patient education is delivered to people with inflammatory arthritis. In 2015, an international group of professionals and patients with inflammatory arthritis developed evidence-based recommendations for patient education [1]. This initiative was supported by the European Alliance of Associations for Rheumatology (EULAR), an organisation representing people with arthritis, health professionals in rheumatology and scientific societies of rheumatology in Europe.

In this study, we wanted to find out whether the recommendations were acceptable to patients and healthcare professionals. We also needed to know what helped people to follow these recommendations and what were barriers to putting them into practice. We surveyed health professionals in 20 countries in Europe, and 3 in Asia (India, Hong Kong and Japan) [2]

Walking is Free – And It Might Help to Prevent Knee Pain

PainRelief.com Interview with:
Grace H. Lo, MD MSc
Assistant Professor of Medicine at Baylor College of Medicine
Chief of Rheumatology and
Investigator at the Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center, Houston, TX.

Grace Hsiao-Wei Lo
Dr. Grace Hsiao-Wei Lo

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

Response: To conduct this study, we used data from the Osteoarthritis Initiative, a research endeavor that has been funded by the NIH and pharma partners for many years.

Our study including people age 50 and older who have signs of osteoarthritis in their knees.

When we looked at those who did not have regular knee pain at the beginning of the study, those who walked for exercise were LESS likely to develop regular knee pain compared to those who do not walk.  

Policymakers Can Mitigate Prescription Opioid Misuse Associated with Delayed Dispensing for Pain Relief after Procedures

PainRelief.com Interview with:
Kao
Ping ChuaMD, PhD
Department of Pediatrics
Susan B. Meister Child Health Evaluation and Research Center
University of Michigan Medical School
Department of Health Management and Policy
University of Michigan School of Public Health, Ann Arbor

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

Response: Opioid prescriptions written by dentists and surgeons are almost always written for the immediate relief of acute pain after procedures. However, current federal and state laws allow these prescriptions to be dispensed well after the time that they are written. When this occurs, that could be a potential sign that the prescription was used in a time frame or for a reason other than intended by the prescriber, both of which are forms of prescription opioid misuse.