Pharmacists May Play An Important Role in Pain Management

PainRelief.com Interview with:
Nathorn (Nui) Chaiyakunapruk PharmD, PhD
Professor, Department of Pharmacotherapy
University of Utah College of Pharmacy
Salt Lake City, UT 84112

Dr. Chaiyakunapruk

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

Response: Pain and pain-related diseases are the major causes of disability and disease burden worldwide. Over the last two decades, as the role of the pharmacist has expanded, pharmacist engagement in disease state management including pain management has been shown to improve clinical outcomes. Several systematic reviews have been conducted to date that assessed the impact of pharmacist interventions on pain management. However, the evidence on the effect of any type of pharmacist intervention, whether led by a pharmacist or in a supportive role, on pain intensity over time in individuals with pain of any etiology is currently inadequate. This study aims to fill that gap.

Study Identify Mechanism That Converts Normal to Chronic Pain

PainRelief.com Interview with:
Dr. Daniela Mauceri PH.D.
Neurobiology
Heidelberg University
Heidelberg Germany

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

Response: Physiological, normal, pain prevents damage to the tissues and, in case of injury, resolves with healing. Pathological, chronic pain however, will persist after injury is mended and can manifest even in absence of causes. The transition from physiological to chronic pain is sustained by alterations of gene expression in the cell belonging to the pain circuitry such as neurons of the dorsal horn spinal cord. Epigenetic changes are important mechanisms regulating gene transcription in mammalian cells and had been previously implicated in pain chronification. A detailed understanding of which epigenetic mechanism would be critical in the establishment of chronic pain was still missing and the identity of the regulated genes still elusive.


PainRelief.com:  What are the main findings?

Response: In our study we described how one particular epigenetic molecule named Histone Deacetylase 4 (HDAC4) is inactivated in the neurons of the dorsal horn spinal cord in persistent inflammatory pain. We also showed that inactivation of HDAC4 leads to increased expression of Organic Anion Transporter 1 (OAT1) and found that OAT1 is responsible for the mechanical hypersensitivity typical of chronic pain. 

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

Response: Our study suggests that finding ways to maintain HDAC4 in an active state might prevent pain chronification by blunting the upregulation of OAT1. Alternatively, blocking OAT1 activity with a pharmacological approach might also be beneficial.

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

Response: Chronic pain is a severe pathological condition affecting a considerable part of the worldwide population. Treatments are still unsatisfactory. Our study, although performed using a mouse model of chronic inflammatory pain puts forward two potential new candidates (HDAC4, OAT1) for not only future investigations but also, importantly, for the development of future therapeutic approaches.

The research work was funded by the CRC1158 on Chronic Pain by the German Research Foundation.

Citation:

Litke, C., Hagenston, A.M., Kenkel, AK. et al. Organic anion transporter 1 is an HDAC4-regulated mediator of nociceptive hypersensitivity in mice. Nat Commun 13875 (2022). https://doi.org/10.1038/s41467-022-28357-x

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Study Evaluates Complex Relationship Between Eating and Chronic Pain

PainRelief.com Interview with:
Paul Geha, M.D
Assistant Professor of Psychiatry
University of Rochester Medical Center
Rochester, NY 14620

Dr. Geha

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

Response: Chronic pain and obesity are interrelated; chronic pain is more common in obese individuals and obese individuals have a higher occurrence of chronic pain conditions such as low-back pain.  The mechanisms behind this association are poorly understood.  In this line of work we are trying to offer an explanation for how chronic pain could lead to obesity. 

We build on two previous facts established in the literature to come up with a new theory. 

First, it is well known that the current obesity epidemic is due to overeating in an environment where highly caloric food is cheap and readily available (e.g., fast food).

Second, our brain imaging research on chronic pain patients established that chronic pain affects the brain motivational pathways (or emotional brain) which are directly involved in feeding decisions, especially the ones that come after satiety.  As such, the emotional brain has been implicated in the decision to overeat on top of satiety. We therefore hypothesized that chronic pain would be associated with disrupted eating behavior that could lead to overeating because of changes in the emotional brain of patients. This is a new approach because the prior thinking posited that obesity and chronic pain are interrelated either because of increased inflammation originating from the increased fat mass or from the fear of movement that patients may have leading to a more sedentary lifestyle. While both theories may be correct, they have never been confirmed.

The current paper builds on a finding we published in PAIN 2014 where we established disrupted eating behavior in patients with chronic low-back pain affecting mainly high-fat foods but not sugary drinks.  In that work we asked patients with long-standing history of chronic low-back pain to sample without consumption pudding with increasing concentration of fat and a sugary drink with increasing concentration of sucrose.  While the sensory experience of the food items was normal in the patients, they reported less pleasure (“liking”) from tasting the fatty pudding but not the sugary drink. On a different session, we brought back the patients and offered them to consume as much as they wanted the pudding that they liked the most during the first testing session. Participants were asked to come hungry.   Chronic back-pain patients showed that their liking and hunger ratings did not predict how much they ate.  Healthy controls showed a linear relationship between liking and hunger ratings and how much they ate. 

In the manuscript we just published in PLOS One we continued this line of work to understand how this disrupted eating behavior sets in as low-back pain develops or subsides.  We wanted to know whether disrupted eating behavior develops in conjunction with chronic pain or because of it.  Hence, we recruited patients with new onset low-back pain (6-12 weeks duration) and tested them in the same way described in our PAIN 2014 paper at baseline and then again at one year as some of them recovered from pain while others became chronic low-back pain because pain persisted at one year follow-up.  In this manuscript we also collected brain images that would allow-us to measure volumes of a key structure in the emotional brain, the nucleus accumbens.  The function of the latter structure is to translate our motivation (e.g., wanting to eat) to actions (e.g. the motor response needed to reach for the food). We wanted to know whether we can link the disrupted eating behavior to measures in the emotional brain. This question was based on our previous finding where we observed that patients at risk of becoming chronic pain or patients already in the chronic phase have a compromised accumbens (i.e. smaller than normal).

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NEJM: Study Recommends Hip Implants Be Fixed with Bone Cement

PainRelief.com Interview with:
Matthew Costa
Professor of Orthopaedic Trauma Surgery
University of Oxford 
Honorary Consultant Trauma Surgeon
John Radcliffe Hospital, Oxford

Dr. Costa

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

Response: The number of patients sustaining a fracture of the hip is increasing rapidly as patients all around the world live into older age. It estimated there will be over 6 million hip fractures by 2050. Approximately half of hip fractures occur at the neck of the thigh bone (femur) and the majority of patients over 60 years with such a fracture are treated with a partial hip replacement in which the head of the femur is replaced with a metal implant (hemiarthroplasty).

There is controversy about how best to fix the hemiarthroplasty implant to the bone of the femur. If the implant is not securely bonded to the patient’s bone it can loosen causing pain and restricting movement and activities of daily living. This study was about the best way to fix the implant to the patient’s bone.

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Identification of the Muscle-Relaxant Carisoprodol (Soma) and Non-Controlled Prescription Substances in Drug-Arrests

PainRelief.com Interview with:
Maaz Siddiqui, BS
Department of Medical Education
Geisinger Commonwealth School of Medicine
Scranton, Pennsylvania

Maaz Siddiqui

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

Response: Over the last twenty years, the rise of deaths due to drug overdoses have been mainly and rightfully attributed to opioids. However, many investigations identify non-opioid drugs and drug classes that additionally contribute to deaths due to polysubstance overdoses. Through the Maine Diversion Alert Program (DAP) data, we examined drugs that often escape the attention of healthcare providers and directly or indirectly contribute to substance misuse, arrests, addiction, and deaths due to overdose.

The goal of this study was to utilize a novel dataset to uncover and identify the noncontrolled drugs that have shown potential to be misused.

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Acupuncture for Pain Relief: Insurance Coverage Increasing But Most Still Self Pay

PainRelief.com Interview with:
Molly Candon, PhD
Research Assistant Professor, Center for Mental Health, Department of Psychiatry
Assistant Professor, Department of Health Care Management
Director, Associate Fellows Program, Leonard Davis Institute of Health Economics
Perelman School of Medicine and the Wharton School
University of Pennsylvania

Molly Candon, PhD Research Assistant Professor, Center for Mental Health, Department of Psychiatry Assistant Professor, Department of Health Care Management Director, Associate Fellows Program, Leonard Davis Institute of Health Economics Perelman School of Medicine and the Wharton School University of Pennsylvania
Dr. Candon

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

Response: Insurance design for pain care, including whether treatments are covered and how generously they are covered, is an important element of access and adherence. Acupuncture therapy is a safe and evidence-based treatment for numerous pain conditions, and our team was curious if acupuncture coverage has changed in recent years given the need for non-opioid treatments during the ongoing opioid epidemic. 

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Total Knee Replacement: Outcomes by Age vs Co-Morbidities

PainRelief.com Interview with:
Juan Ignacio, Teves
Agustin, Garcia-Mansilla

Italian Hospital of Buenos Aires

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

Response: It is well known that the increased life expectancy of the general population leads to an increase in the number of prosthetic replacement surgeries in the years to come. A concern of patients who consult for this type of procedure is whether age alone is a risk factor for this surgery and the literature is not conclusive about whether age or comorbidities are more important in postoperative results.

For this reason, we decided to compare two series of patients, some older than 80 years and others younger, to determine whether or not age influences the result of total knee replacement.

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Migraine: Genetic Factors May Differ Between Men and Women

PainRelief.com Interview with:
Matthew S. Panizzon, Ph.D.
Associate Professor
Department of Psychiatry
Center for Behavior Genetics of Aging
University of California San Diego

Dr. Panizzon

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

Response: Migraine is a severe neurological disease that affects over 12% of the population.  Women are also much more likely to suffer from migraine then men.  Despite how common it is, the factors that contribute to migraine are poorly understood.

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Study Compares PRP to Placebo For Pain Relief in Knee Arthritis

PainRelief.com Interview with:

Professor Kim Bennell FAHM
Barry Distinguished Professor | NHMRC Leadership Fellow
Dame Kate Campbell Fellow
Centre for Health Exercise and Sports Medicine
Department of Physiotherapy
Melbourne School of Health Sciences
The University of Melbourne, Victoria Australia

Prof. Bennell

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

Response: Osteoarthritis is a common chronic painful joint condition with no cure that often leads to costly joint replacement surgery. Treatments are needed that can not only reduce symptoms but also slow structural progression of the disease in order to reduce the burden of knee OA.  There are no approved disease-modifying treatments available at present. 

Platelet-rich plasma (PRP) injections have become a widely used treatment for knee osteoarthritis (OA) in recent years despite the fact that the evidence to support their effects is limited and not of high quality. For this reason, clinical guidelines currently do not recommend PRP for the management of knee osteoarthritis.

To address this gap in knowledge, our study aimed to compare the effectiveness of PRP injections to reduce knee pain and slow loss of medial tibial cartilage volume over a 12-month period. We did this by conducting a clinical trial of 288 people with mild to moderate knee OA. The study included a placebo group where participants were injected with saline into the knee. Participants and the injecting doctors were blind as to whether PRP or saline was injected into the knee.

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Case Report Describes Pain Relief from Chronic Migraines with LIFE Diet

PainRelief.com Interview with:
David M. Dunaief, M.D.

Principal Investigator
MedicalCompassMD.com

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

Response: As an internist focusing on dietary intervention, I have been caring for patients with chronic diseases for the past 12 years. Many of my patients have had rapid, marked improvements when they adhere to my LIFE (Low Inflammatory Foods Everyday) diet. The diet, as well as objective evidence that it reduces systemic inflammation (lowers serum C-reactive protein levels), has been described in the peer-reviewed publications:

https://journals.sagepub.com/doi/full/10.1177/1559827619894954 

and https://journals.sagepub.com/doi/full/10.1177/1559827620962458.

In addition to improving migraines, the diet has improved symptoms and blood chemistries in patients with high blood pressure, high cholesterol, diabetes, cancer, auto-immune diseases, inflammatory bowel disease, and others. In this case report, we describe a patient who suffered from debilitating migraines for 12.5 years, and who had minimal benefit from avoiding dietary triggers or medications. Within 3 months of adopting the LIFE diet, he was migraine free and remained that way for 7.5 years.

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