Category Archives: Pain-Relief

Migraine: Remote Electrical Neuromodulation For Pain Relief in Adolescents

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PainRelief.com Interview with:
Andrew D. Hershey, MD, PhD, FAAN, FAHS
Endowed Chair and Director of Neurology
Professor of Pediatrics and Neurology
Director, Headache Center
Cincinnati Children’s Hospital Medical Center
Cincinnati, OH 45229
University of Cincinnati, College of Medicine

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

Response:  Migraine is a common and debilitating disease, affecting 1 in 10 children and adolescents worldwide. Refractory migraine in adolescents may be associated with poorer academic performance, reduced school attendance, and a negative effect on social interactions. Current acute treatments for adolescents with migraine are mostly pharmacological. These treatments may cause side effects, and their frequent use may potentially lead to medication overuse headache. Additionally, their efficacy may be variable or inadequate. Thus, there is a great unmet need for new safe and effective acute treatments for adolescents with migraine headaches.

Remote Electrical Neuromodulation (REN) is a non-pharmacological, non-invasive neuromodulatory treatment that has been approved by the US FDA for acute treatment of the headache attacks of migraine in patients 12 years of age or older. The REN device (Nerivio®) is a small stimulator controlled by the user via a smartphone application and activates one of the body’s own pain suppression system by inducing weak electrical currents. These currents stimulate nerve fibers in the upper arm to activate an endogenous descending pain inhibition mechanism termed Conditioned Pain Modulation (CPM). Clinical trials of REN have shown efficacy and safety of the treatment in adolescents 12 and older, as well as in adults.

The current study is the first to compare REN and standard-care treatments (over the counter medications and triptans) in adolescents.

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Multimodal Analgesia For Pain Relief After Joint Replacement

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PainRelief.com Interview with:

Joseph Albert Karam, MD
Assistant Professor of Clinical Orthopaedic Surgery
Associate Program Director, Orthopaedic Surgery Residency
The University of Illinois at Chicago

Joseph-Karam
Dr. Karam

PainRelief.com:  What is the background for this study?Would you describe the multimodal pain plan?

Response: Pain after joint replacement surgery has been historically managed by protocols centered on opioid medication. Given the side effects associated with these medications, the risk for long term addiction and evidence showing that opioids are not necessarily the best at treating pain perioperatively in joint replacement, multimodal pain management protocols have been established. These protocols utilize different families of medications that target pain at different steps in the pain pathway.

The exact protocol varies from one institution to the other but typically include systemic agents such as acetaminophen, non-steroidal anti-inflammatories/COX-2 inhibitors, gabapentinoids, corticosteroids, as well as loco-regional interventions such as local infiltration analgesia and regional nerve blocks. ‘Pre-emptive analgesia’ which most commonly uses a nonsteroidal anti-inflammatory, acetaminophen and/or a gabapentinoid has also been demonstrated to play a key role. Additional measures such as NMDA antagonists and epidural catheters can also be used in select cases. Non-pharmacological treatments such as cryotherapy, cryoneurolysis and electrical nerve stimulation have also been described. Our preferred institutional protocol is detailed in the paper.

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Runners: Leaning Forward Increases Force on Hip Extensors

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PainRelief.com Interview with:
Anna Warrener Ph.D.
Department of Anthropology
University of Colorado Denver
Denver, CO

Dr. Warrener

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

Response: We became interested in looking at trunk position during running because one of us (Daniel Lieberman) had anecdotally observed people running with a variety of trunk positions, and when we went looking for academic literature on the topic, we found it was fairly scarce. We suspected that trunk position could have a major impact on the forces experienced by the lower limbs during running and even affect aspects of gait (stride length and time). So we developed a model predicting how these forces and movements might change as trunk flexion/forward leaning increased.

Our primary predictions were that more forward lean would increase “overstride” which is the distance in side view between the hip and the heel as it contacts the ground (a measure of how far your are extending your leg when you step). This in turn would increase the impact forces experienced by the lower limb at initial contact which have previously been shown to increase the risk of repetitive stress injuries. We also predicted that stride would get longer and take more time because extending the leading leg out farther forward (overstriding) would be necessary to keep the body center of mass within a base of support above the limbs. This more extended limb, we predicted, would change the angles and forces about the ankle, knee and hip joints.

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Prescription Opioids for Pain Relief in Youth Decreased in Recent Years

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PainRelief.com Interview with:

Madeline H. Renny, MD
Postdoctoral Fellow, Department of Population Health
Clinical Instructor, Department of Emergency Medicine and Pediatrics
New York University Grossman School of Medicine
New York, New York

Dr. Renny

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

Response: Prescription opioids are involved in over half of opioid overdoses among youth.  Additionally, prescription opioid use is associated with risks of future misuse, adverse events, and unintentional exposures by young children.  While there are several studies on opioid prescribing in adults, few studies have focused on the pediatric and adolescent population.  In the last year, postoperative guidelines for opioid prescribing for children and adolescents were released, but there remain no national guidelines on general opioid prescribing for youth. 

To our knowledge, no prior national studies have examined trends in important opioid prescribing practices, including amount prescribed, duration, high-dosage, and extended-release/long-acting (ER/LA) opioid prescriptions, in this subset of the population; a necessary step in understanding the opioid epidemic and in developing targeted interventions for youth. 

Therefore, we performed a cross-sectional analysis of U.S. opioid prescription data to investigate temporal trends in several key opioid prescribing practices in children, adolescents, and younger adults in the U.S. from 2006-2018.

PainRelief.com: What are the main findings?

Response: We found that opioid dispensing rates declined significantly for children, adolescents, and younger adults since 2013. When examining trends in opioid prescribing practices, there were differences based on age group. For adolescents and young adults, rates of long-duration and high-dosage opioid prescriptions decreased during the study period, whereas there were increases in these rates for younger children.  

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

Response: Dispensed opioid prescriptions for youth have significantly decreased in recent years.  These findings are consistent with prior studies in children and adults, suggesting that opioid prescribing practices may be improving. Additionally, the decrease in rates of high-dosage and long-duration prescriptions in adolescents and young adults is encouraging in the context of research showing associations with these prescribing practices and opioid use disorder and overdose. However, opioids remain commonly dispensed to youth and potential high-risk prescribing practices (long-duration, high-dosage, and ER/LA prescriptions) appear to be common, especially in younger children.  

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

Response: The increase in rates of potential high-risk prescribing practices in young children was an unexpected finding and warrants future study. Due to the limitations of our database (no clinical information, including diagnoses or indications for prescription), we were unable to determine the appropriateness of opioid prescribing practices (e.g., whether a prescription was for a child with cancer or for a child with an acute injury).  Our two sensitivity analyses were performed to try to identify a subset of patients with chronic illness and both showed no differences in trends.  However, it will be important to further investigate these opioid prescribing practices using a database with clinical information to better understand these findings in young children.

Further research investigating specific opioid prescribing practices may inform targeted interventions, including pediatric and adolescent-specific opioid prescribing guidelines, to ensure appropriate opioid prescribing in this population. 

No disclosures

Citation:

Renny MH, Yin HS, Jent V, Hadland SE, Cerdá M. Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA Pediatr. Published online June 28, 2021. doi:10.1001/jamapediatrics.2021.1832

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Brain Implant Targets Chronic Pain

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PainRelief.com Interview with:
Jing Wang MD PhD
Department of Anesthesiology, Perioperative Care and Pain
Department of Neuroscience & Physiology
NYU Langone
Neuroscience Institute, New York University School of Medicine
New York, NY

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

Response: The motivation for this study is three fold.

First, there are no objective ways to measure pain in preclinical models that could facilitate study of pain mechanisms and analgesic screening.

Secondly, while pain is assessed by patient report, a lack of alternative pain measures in humans hinders clinical treatment of pain in patients whom we cannot assess pain readily, such as patients who suffer from dementia or very young children.

Thirdly, chronic pain patients often complain of spontaneously occurring pain episodes which are unpredictable, and we currently do have a way to target specific pain episodes, and so we treat pain with scheduled drugs, leading to under- or over-treatment. We designed a prototype closed-loop neural interface, employing computerized brain implants, to address these challenges. We found that this interface quite effectively relieves short-term and chronic pain in rodents. In this study, we designed a computerized brain implant to detect and relieve bursts of pain in real time. We implanted electrodes in a region of the brain called anterior cingulate cortex, an important area for the processing the emotional component of pain. We used these implanted electrodes to measure neural activity in this brain region, and then applied machine learning algorithm to detect a change in neural activity in this region which signals the onset of pain experience. The detected pain signal then triggered stimulation of another brain region, called prefrontal cortex, which is known to suppress pain. In this way, our device automatically detected and treated pain with minimal delay, as shown by a number of pain behavior assays in rats. The device is also the first of its kind to target chronic pain, which often occurs without being prompted by a known trigger.

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

Response: Our experiments offer a blueprint for the development of brain implants to treat pain syndromes and other brain-based disorders, such as anxiety, depression, and panic attacks. The advantage of our approach is that it targets symptoms in a time-sensitive manner. Our approach can detect pain as it occurs in real time. In its current form, it already becomes a powerful tool to screen drugs. In our current system, pain detection is coupled with neurostimulation treatment. But it can also be coupled with drug delivery. In this way, our system can be used to screen new analgesic drugs. It can also be used to screen other neurostimulation techniques.

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

Response: We are already working on modifications of our system to move it closer to translation to the bedside.

First, we would like to improve pain decoding accuracy. We are doing that be recording from multiple brain regions.

Second, the current treatment requires injection of viral vectors and foreign proteins, which are not realistic in human use, and thus we are working to use more clinically feasible approaches to treat pain in our closed-loop device.

Finally, we are working on making the device non-invasive – free of brain implants.

Citation:

Zhang, Q., Hu, S., Talay, R. et al. A prototype closed-loop brain–machine interface for the study and treatment of pain. Nat Biomed Eng (2021). https://doi.org/10.1038/s41551-021-00736-7

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

UTHealth SA Researchers Study Link Between Omega Fatty Acids and Peripheral Neuropathy

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PainRelief.com Interview with:
Ken M. Hargreaves, DDS, PhD
Professor and Chair
Department of Endodontics
The University of Texas Health Science Center at San Antonio

Dr. Hargreaves

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

  1. About ten years ago our lab found that the omega-6 lipids can generate pain-producing lipids by activating the capsaicin (found in red hot chili) receptor. At about that time, other scientists reported that a related lipid, the omega-3, can generate pain-relieving lipids. 
  2. Scientists have known for a long time that both omega-6 and omega-3 lipids are “essential fatty acids”, meaning that our body does not make them so they must come in our diet.
  3. So, we tested the idea that a high omega-6 diet would be a risk factor for pain. That is exactly what we found: mice fed a high omega-6 diet had greater pain-like responses after inflammatory or neuropathic injury.
  4. Mice with diabetic neuropathy actually had worsening of symptoms after a high-6 diet. Importantly, this was largely reversed in mice fed a high omega-3 diet.
  5. We also found a drug that blocked the release of the omega-6 lipids from cell membranes and this drug significantly reduced diabetic neuropathy pain in mice.
  6. We then transitioned to clinical research.  We collected ankle skin biopsies from participants with type II diabetic neuropathy and from age- and sex-matched controls.  The tissue levels of omega-6 lipids predicted pain levels, with higher omega-6 lipids associated with higher reports of pain.

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

  1. Dietary recommendations have been made for patients with many disorders such as cardiovascular disease, diabetes and autoimmune disease.  Our findings suggest that pain should be added to this list and that a diet enriched with a higher ratio of omega-3 to omega-6 lipids may help to reduce pain.
  2. Examples of foods with a high omega 3:6 ratio are tune (25:1 of omega 3:6), broccoli (6:1), flax seeds (4:1), mango (3:1), spinach (5:1) and lettuce (2:1).  Examples of foods with excessive omega-6:3 would include many processed foods cooked in vegetable oils such as French fries, hamburgers and the like.

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

Response: Our study has identified several paths for future research including a clinical trial evaluating the effects of a high omega 3:6 diet on pain, development of new drugs to block omega-6 release and the possible development of lipids as a biomarker for pain.

No disclosures.  

Citation:

Boyd, J.T., LoCoco, P.M., Furr, A.R. et al. Elevated dietary ω-6 polyunsaturated fatty acids induce reversible peripheral nerve dysfunction that exacerbates comorbid pain conditions. Nat Metab 3, 762–773 (2021). https://doi.org/10.1038/s42255-021-00410-x

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Green Light Therapy Can Augment Traditional Pain Relief Methods

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PainRelief.com Interview with:
Mohab Ibrahim, MD., Ph.D
Associate Professor, Departments of Anesthesiology, Neurosurgery, and Pharmacology.
Director, Chronic pain clinic. 
Director, Chronic pain fellowship. 
Medical Director, Comprehensive Pain and Addiction Center
Banner-University Medical Center
University of Arizona

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

Response: This study is the continuation of the green light story we first published in 2017. Our first paper in 2017 investigated the effect of green light on pain behavior in animals. This idea was inspired by my brother who suffers from headaches and finds relief in green spaces. My brother’s experience with green spaces inspired me to look initially into green light therapy for pain in rodents which resulted in our first publication in 2017.  Because green light therapy decreased pain behavior in animals coupled with the safety profile of green light (we use low-intensity green light), we obtained approval from the University of Arizona to conduct human trials. This has resulted in two clinical trial papers that were recently published.

We have shown that green light exposure decreased the severity of pain in patients with fibromyalgia and also decreased the intensity and frequency of migraine headaches in migraine patients. At this point, we wanted to explore the mechanism(s) of action and explain how green light works. We had some preliminary data from our initial publications pointing towards the endogenous opioid system. Therefore, we decided to explore the endogenous opioid system in more detail in the HIV-induced neuropathy model in rodents. Our findings indicate that green light reversed hypersensitivity in a model of HIV-related neuropathy in rodents by stimulating the endogenous opioid system. Green light exposure significantly increased the CSF levels of β-endorphin and proenkephalin, but not dynorphin. The µ- and δ-opioid receptors appeared to be key actors in green light-induced antinociception. 

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

Response: Chronic pain is a complicated medical condition with several dimensions. Chronic pain may affect sleep quality, life quality, and may result in depression.

The management of chronic pain requires a deep appreciation of the factors involved and necessitates the evaluation of a pain specialist and the collaboration of several medical specialists.

Non-pharmacological methods can be used to complement current pharmacological and procedural interventions to control pain.

Color and light therapy are still in their infancy and we still need to learn more about them. More research and more funding are needed to better understand the biological

Green light therapy can augment current traditional methods to control pain.

If you live in an area with trees or forests, you can enjoy free green light therapy while walking and exercising. It’s a win-win situation.

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

Response: We and other labs have shown that different colors of light have biological effects. It’s important that we start looking at new indications for light therapy as well as mechanisms of action. Light therapy is relatively a new field and there may be some or a lot of skepticism in the scientific community about its benefits. It may be time to start thinking about organizing regional/national annual meetings focused on the medical benefits of light therapy. This type of meeting will foster collaborations among physicians and scientists and attract more attention and interest in this field.

Finally, looking at the financial burden secondary to the price and cost of medications and the side effects associated with some of these interventions, light therapy may offer a safer complementary tool that is more affordable and has fewer side effects than a significant number of medications. While light therapy may not replace traditional medications, it may decrease the amount of medications needed.

PainRelief.com: Is there anything else you would like to add?

Response: Even though green light therapy is easy to do and relatively safe, I advise anyone who wishes to try it to consult their physicians first. Some medical conditions may not be suitable for extended visual light exposure. Always check with your doctor before you start any new therapy. Also, please do not stop ANY medication you are on without consulting with your physician first. Some medications should not be stopped abruptly.

Finally, as a disclosure, I have a patent for the green light therapy, and it is currently being commercialized.

Citation:

Laurent F. Martin, Aubin Moutal, Kevin Cheng, Stephanie M. Washington, Hugo Calligaro, Vasudha Goel, Tracy Kranz, Tally M. Largent-Milnes, Rajesh Khanna, Amol Patwardhan, Mohab M. Ibrahim,

Green light antinociceptive and reversal of thermal and mechanical hypersensitivity effects rely on endogenous opioid system stimulation,

The Journal of Pain, 2021,

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.

Cognitive-Behavioral Couple Therapy Provided Pain Relief from Vulvar Pain

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PainRelief.com Interview with:
Sophie Bergeron, Ph.D.
Canada Research Chair in Intimate Relationships and Sexual Wellbeing
Past-President, Society for Sex Therapy and Research
Professeure titulaire/Professor
Département de psychologie 
Université de Montréal 

Dr. Bergeron

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

Response: Chronic pain problems involving the female reproductive system are major health concerns in women of all ages. As conditions which are poorly understood and often misdiagnosed or ignored, they entail a great personal cost to patients and a significant financial cost to society.

One such condition is vulvodynia, or chronic unexplained vulvar pain. Up to 8% of women under 40 may experience idiopathic vulvar pain during their lifetimes. Provoked vestibulodynia (PVD) – an acute recurrent pain localized within the vulvar vestibule and experienced primarily during sexual intercourse – is suspected to be the most frequent cause of vulvodynia in premenopausal women.

Despite its high prevalence and negative impact on psychosexual functioning of both affected women and their partners, there has been a paucity of controlled research to provide empirically validated treatments for afflicted couples. This randomized clinical trial compared a novel cognitive-behavioral couple therapy (CBCT) and topical lidocaine for PVD.

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Fusion vs Replacement for Pain Relief from Ankle Arthritis

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PainRelief.com Interview with:
Bruce J. Sangeorzan, M.D., Professor
Director, RR&D Center for Excellence in Limb Loss Prevention and Prosthetic Engineering
Veterans Affairs
University of Washington

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

Response: We began a series of studies in the early 2000’s when ankle replacement was limited to a few centers like our own. We knew that ankle arthrodesis– or fusion—was an effective treatment for ankle arthritis. But ankle fusion is not appropriate for some people and it also results in loss of ankle motion. There were a growing number of ankle replacements being done but little was known about their effectiveness or how long they last.

We wanted to study whether replacement and fusion were comparable for pain relief and activity and wanted to know if maintaining motion of the ankle (by using a replacement) would have an advantage without additional risk. Three studies were done involving more than 800 patients from 6 centers.

This most recent study compared two groups of patients who had similar amount of pain and activity before treatment. All of the patients had already tried non -surgical solutions such as activity modification, bracing and injections with out improvement. One group had fusion of the ankle and the other had replacement of the ankle. Patients were questioned and examined four years or more after surgery and compared to their condition before treatment.

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No Pain Relief Found With Paracetamol (acetaminophen) for Acute Back Pain

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PainRelief.com Interview with:
Christina Abdel Shaheed PhD
Researcher and Academic
University of Sydney

Dr. Abdel Shaheed

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

Response: Paracetamol (acetaminophen) is one of the most widely used drugs for pain relief globally. Our study (https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50992) examined the evidence on the efficacy of paracetamol versus placebo for 44 different pain conditions. There is strong evidence paracetamol provides greater pain relief than placebo for four conditions: craniotomy, knee or hip osteoarthritis, tension headache and perineal pain following childbirth, however sometimes the effects were very small.

Paracetamol was no more effective than placebo for acute low back pain. There is uncertainty regarding the benefits of paracetamol for the remaining 39 pain conditions. To note, most studies evaluated single doses of the pain reliever, which does not reflect typical use of the medicine.

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

Response: If people are considering paracetamol for their pain, the recommendation is to:

  • Stick within the safe limits for using paracetamol (maximum 4 g daily for adults, which will vary depending on the formulation used).
  • Bear in mind there are different types of paracetamol products (long-acting, which should be taken less frequently, versus short-acting); and cold and flu preparations (including decongestant) and popular over-the-counter products for pain relief (including ibuprofen) can also contain paracetamol.
  • Do not use paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
  • Consider combining the medicine with other non-drug strategies to optimise pain relief, particularly for conditions like osteoarthritis e.g. exercise and healthy eating.

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

Response: High quality clinical trials evaluating typical use of paracetamol are needed to resolve the uncertainty around its effectiveness for the majority of pain conditions.

Disclosures: Some of the authors on this study were also involved in the PACE trial which evaluated the efficacy of paracetamol vs placebo for acute low back pain.

Citation:

Abdel Shaheed, C., Ferreira, G.E., Dmitritchenko, A., McLachlan, A.J., Day, R.O., Saragiotto, B., Lin, C., Langendyk, V., Stanaway, F., Latimer, J., Kamper, S., McLachlan, H., Ahedi, H. and Maher, C.G. (2021), The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews. Med J Aust, 214: 324-331. https://doi.org/10.5694/mja2.50992

The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.