Targeted Smartphone Exercise Program Can Provide Pain Relief from Knee Arthritis

PainRelief.com Interview with:
Ana M Valdes MA PhD
Professor in Molecular and Genetic Epidemiology
NIHR Nottingham Biomedical Research Centre – Research Area Lead
Associate Editor European Journal of Clinical Nutrition
School of Medicine
University of Nottingham

Dr. Valdes

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

Response: Knee osteoarthritis and knee pain affect a large proportion of middle age and aging individuals and this are  an increasing problem. Physical exercises aimed at strengthening and stabilising the muscles in the legs and hips  are known to be highly effective in reducing pain and improving the ability to walk and get on with life. But a key challenge is how to deliver such gradual exercises in a way that does not require people to travel to see a physiotherapist or a doctor, particularly given the issues raised by  lockdown both in terms of the Covid-secure challenges face to face visits and also given the strain that the pandemic has put on health services.  

Our  study was the first randomised controlled trial in the UK where we were had people with painful knee osteoarthritis either do only what their doctors normally recommend or, in addition, follow a programme of exercised developed in Sweden delivered via  smartphone app. The research participants were assessed for knee inflammation, knee pain, pain sensitivity around the knee, muscle strength, and ability to walk and get up from a chair both before and after the 6 week smartphone delivered intervention (or a 6 week period simply following any advice they had from their family doctor).

Transcranial Neuromodulation Studied for Pain Relief

PainRelief.com Interview with:
Markus Ploner MD
Professor of Human Pain Research
Department of Neurology
Technische Universität München
Munich, Germany

Prof. Ploner

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

Response: Recent studies in humans and animals have revealed that pain is associated with rhythmic brain activity termed neural oscillations. In particular, changes of neural oscillations at alpha (8 – 13 Hz) and gamma (30 – 100 Hz) frequencies in somatosensory and prefrontal brain areas have been related to pain. Thus, modulating neural oscillations to eventually modulate pain is a promising novel approach for pain treatment.

Transcranial alternating current stimulation (tACS) is an emerging neuromodulation technique which aims at non-invasively modulating neural oscillations in the human brain. During tACS, a weak alternating current is applied to the scalp with the goal of entraining neural oscillations at the stimulation frequency, thereby increasing their amplitude. The appeal of tACS is that it is non-invasive, safe, cost-efficient, and potentially mobile which allows for broad clinical applications. Thus, tACS is increasingly explored as a new treatment approach for neuropsychiatric disorders.

In our study, we therefore explored the potential of tACS to modulate pain. We systematically applied tACS at alpha and gamma frequencies or sham tACS over somatosensory and prefrontal cortices during tonic experimental pain in healthy human participants.

PainRelief.com: What are the main findings?

Response: Our main findings are that, using the current setup, tACS did not modulate the perception of pain. Bayesian statistics further supported a lack of tACS effects in most conditions including prefrontal and gamma tACS. The only exception was tACS at alpha frequencies over somatosensory cortex where evidence for tACS effects on pain perception was inconclusive. 

PainRelief.com: What should readers take away from your report?

Response: Readers might take away three key points.

First, neurophysiological studies indicate that modulating neuronal oscillations to eventually modulate pain is a promising novel approach for the treatment of pain.

Second, tACS is one non-invasive and simple approach to modulate neuronal oscillations.

Third, our mostly negative findings show that we are not there yet.    

PainRelief.com: What recommendations do you have for future research as a result of this work?

Response: A very general recommendation is that rigorous, well-controlled and transparent studies are needed to further explore the potential of tACS (and other neuromodulatory techniques) for treating pain. Furthermore, we should ideally make all our data available to the public so that the whole research community can take advantage of them. Finally, to advance the field, we should not only publish positive but also negative findings, as done here. 

A more specific recommendation is that modulating neuronal oscillations at alpha frequencies over somatosensory brain areas is the most promising approach for further tACS studies.

Citation:

May ES, Hohn VD, Nickel MM, Tiemann L, Gil Ávila C, Heitmann H, Sauseng P, Ploner M. Modulating Brain Rhythms of Pain using Transcranial Alternating Current Stimulation (tACS) – A Sham-controlled Study in Healthy Human Participants. J Pain. 2021 Apr 9:S1526-5900(21)00191-7. doi: 10.1016/j.jpain.2021.03.150. Epub ahead of print. PMID: 33845173.

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Redheads May Experience Pain Differently

PainRelief.com Interview with:
David E. Fisher MD, PhD
Edward Wigglesworth Professor & Chairman
Dept of Dermatology
Director, Melanoma Program MGH Cancer Center
Director, Cutaneous Biology Research Center
Massachusetts General Hospital
Harvard Medical School

Dr. Fisher

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

Response: This study followed up on prior published work from other investigators which demonstrated altered pain thresholds in humans and mice who had the redhair light-skin phenotypes.  The key focus of our current study was to firstly validate the overall findings, and then to  the mechanistic basis for the differences.  Of note, our laboratory does not primarily focus on the science of pain or nociceptive, but rather on skin and melanoma. For this reason we had accumulated a number of valuable genetic models of pigmentation (such as redhaired mice harboring alterations in the identical gene implicated in human red hair).  These mouse models served as the key resources for carrying out the current study.

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Migraine: Galcanezumab (Emgality®) for Pain Relief in Patients with Previous Preventive Medication Failures

PainRelief.com Interview with:
Dulanji K. Kuruppu, MD

Medical Advisor, Migraine & Headache Disorders
US Medical Affairs
Eli Lilly and Company
LTC-South, Indianapolis IN 46221 U.S.A.

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

Response: Galcanezumab is a monoclonal antibody that binds to calcitonin gene-related peptide (CGRP) and is approved for the preventive treatment of migraine and for the treatment of episodic cluster headache in adults. The CONQUER study assessed the efficacy and safety of galcanezumab in 462 adults with episodic or chronic migraine who previously did not benefit from 2 to 4 standard-of-care migraine preventive medication categories. This study consisted of a 3-month double-blind, placebo-controlled period (months 1-3) followed by an open-label period (months 4-6). The primary endpoint, which was the mean change from baseline in the number of monthly migraine headache days for galcanezumab vs placebo over months 1-3, was met. In this post-hoc analysis, we assessed onset of effect of galcanezumab in the CONQUER population.

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Radiofrequency Ablation Provides Faster Pain Relief for Patients with Bone Metastases

PainRelief.com Interview with:
Jason R. Levy, MD, FSIR
Vascular and Interventional Radiologist
Northside Hospital in Atlanta, Georgia

Dr. Levy

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

Response: For patients whose cancer has spread to their bones, their pain is often treated using radiation, which can take weeks to provide relief. In our study we examined the effectiveness of Radiofrequency Ablation (RFA) for the palliative treatment of patients with painful osseous metastases.

Radiofrequency Ablation is a minimally invasive treatment that uses radiofrequency waves to create heat that kills tumor cells and destroys nerve fibers to reduce transmission of pain signals to the brain. The procedure was followed up with cement injections to help stabilize the bone and prevent fractures that often occur following other treatments.

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Aimovig® plus OnabotulinumtoxinA (onabot) For Migraine Pain Relief

PainRelief.com Interview with:
Fred Cohen, MD
Department of Medicine, 
Montefiore Medical Center and the Albert Einstein College of Medicine
Bronx, New York

Dr. Fred Cohen

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

Response: OnabotulinumtoxinA (onabot) and calcitonin gene-related peptide monoclonal antibodies (CGRP-targeted mAbs) are two medications used to treat chronic migraine. While both have been shown to significantly reduce monthly headache days, they are some patients that require further treatment after receiving one of these therapies. Prior to this study, there was limited data on the efficacy and safety of concomitant treatment with onabot and a CGRP-targeted mAb. 

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Lower Ketamine Dose Can Provide Pain Relief for Acute Pain in ER

PainRelief.com Interview with:
Shannon Lovett, MD, FACEP
Associate Professor
Associate Medical Director, ED Clinical Operations
Department of Emergency Medicine
Stritch School of Medicine

Dr. Lovett

PainRelief.com:  What is the background for this study?  What types of pain were treated?

Response: The opioid crisis has led emergency medicine providers to utilize other medications to treat pain, including ketamine. Prior to our study, there was a range of recommended ketamine doses in the treatment of pain, and the most frequently studied dose demonstrating analgesic efficacy was 0.3 mg/kg. We challenged that dose by comparing a lower dose, 0.15 mg/kg, to 0.3 mg/kg of IV ketamine for acute moderate to severe pain in the emergency department. We treated acute (onset < 7 days) abdominal, back, flank, musculoskeletal, and headache pain. 

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Topical NSAIDS for Knee Osteoarthritis Pain Relief

PainRelief.com Interview with:
Dylan Wolff
M.D. Candidate

Dylan Wolff
M.D. Candidate
Dr. Mary Mulcahey

Mary K. Mulcahey, MD, FAAOS, FAOA
Director, Women’s Sports Medicine Program
Associate Professor
Assistant Program Director
Department of Orthopaedic Surgery
Tulane University School of Medicine
New Orleans, LA


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

Response: Osteoarthritis Research Society (OARSI) guidelines include topical non-steroidal anti-inflammatory drugs (NSAIDs) as a level 1A recommendation for non-operative management of knee osteoarthritis, but previous reviews have demonstrated that clinical adoption of this treatment option lags. We conducted a systematic review and meta-analysis of 18 studies evaluating diclofenac, ketoprofen, and ibuprofen in topical preparations. We found that they are safe and effective for reducing pain and improving physical function in patients with knee osteoarthritis. Diclofenac had the strongest quality and number of studies and showed a moderate effect size for symptomatic improvement. With regards to safety, adverse events were low in the topical treatment groups, and topical preparations containing dimethyl sulfoxide (DMSO) showed a higher odds ratio for adverse events than preparations without DMSO. 

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Chronic Pain Sufferers Face Different Pain Triggers During Pandemic

MedicalResearch.com Interview with:
Rubén Nieto
eHealth Lab Research Group,
Faculty of Health Sciences
Universitat Oberta de Catalunya
Barcelona, Spain

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

Response: The COVID-19 pandemic is one of the most serious global challenges to have faced healthcare and society in the last century, taking a drastic toll on the world’s population. It has caused deaths, worsened people’s quality of life and upended the economy, among other consequences. Despite this, there is little research on how people are coping with the pandemic. In our opinion, it is of particular interest to study people with chronic pain, since COVID-19 and the circumstances surrounding it can have a greater impact on them.

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Fibromyalgia: Evaluation of Pain Relief Therapies

PainRelief.com Interview with:
VINÍCIUS CUNHA OLIVEIRA, PhD 
Departamento de Fisioterapia – UFVJM 
Brasil

Dr. Oliveira

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

Response: Fibromyalgia is a chronic health condition of unknown etiology characterized by generalized body pain, fatigue, sleep disturbance, impaired cognition, and anxiety. It causes disability, lowers quality of life and is responsible for with high direct and indirect costs. Many therapeutic options are available and delivered to these patients and it is important to patients and clinicians to understand the average effects sizes of these interventions in order to make their choices.

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