Category Archives: Pain-Relief

Conditioned Open-Label Placebos Provide Pain Relief in Some Post-Surgical Patients

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PainRelief.com Interview with:
Kristin Schreiber, MD, PhD
Neuroscientist and Clinical Regional Anesthesiologist
Brigham and Women’s Hospital
Assistant Professor of Anesthesia
Harvard Medical School

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

Response: Traditionally, the placebo effect has involved deceiving patients, where they think they may be taking a real medication. “Open-label placebos” are when placebos are given to patients, and patient are told that they are in fact a placebo. Recent research has suggested that these open-label placebos may actually reduce a number of symptoms in patients, including chronic low back pain. We were interested whether this strategy could be used to help reduce pain and opioid use around the time of surgery. We decided to combine the use of OLP with a conditioning approach, so that anytime a patient took an opioid analgesic, they would take the open-label placebo, so that the OLP pills would be associated with pain relief. That way when patients took them on their own, it would serve to trigger an expectation of pain relief, which is thought to at least partially explain the placebo effect.  

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Study Discusses Overlap of Opioid Therapy for Physical and Social Pain Relief

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PainRelief.com Interview with:
Mark Sullivan, MD, PhD
Professor, Psychiatry and Behavioral Sciences
Adjunct Professor, Anesthesiology and Pain Medicine, Bioethics and Humanities
Medical Co-Director, UW Telepain

Dr. Sullivan

University of Washington
Seattle, WA 98195

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

Response: This is a review paper than synthesizes neuroscience, pharmacological and epidemiological research on the opioid epidemic. It has been known since at least the 1970s that opioids treat not only pain due to physical damage, but also separation distress.

Functional neuroimaging (fMRI) studies have shown that physical pain (tissue injury) and social pain (social rejection) activate the same limbic brain centers (insula, cingulate cortex). Both chronic pain and depression are associated with dysfunction of the endogenous opioid system in the human brain. Studies of opioid prescribing have shown that patients with chronic pain, who also have anxiety and depressive disorders are more likely to be prescribed long-term opioid therapy at high doses and with concurrent sedatives.

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Challenges in Providing Osteoarthritis Pain Relief

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PainRelief.com Interview with:
Rebecca L Robinson
Patient Outcomes and Real-World Evidence
Eli Lilly and Company, Indianapolis, IN

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

Response: Osteoarthritis (OA) pain is unfortunately common and greatly affects patients’ quality of life. Treatment varies from patient to patient and can include nonpharmacologic therapies, over-the-counter (OTC) and prescription pain medications, as well as surgery. The combination of these treatment modalities and especially the use of acetaminophen, NSAIDs or opioids in OA patients has not been examined thoroughly. This study helps to address this gap while also demonstrating variations in treatment received by patients with different levels of pain severity. We analyzed data from the United States OA Adelphi Disease Specific Programme (DSP), which links patient and physician perspectives on the management of OA via cross-sectional surveys.

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Does Adding Gabapentinoids to Opioids For Surgical Pain Relief Reduce Risk of Overdose?

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MedicalResearch.com Interview with:
Katsiaryna Bykov, PharmD, ScD
Instructor in Medicine, Harvard Medical School
Associate Epidemiologist
Division of Pharmacoepidemiology and Pharmacoeconomics
Brigham and Women’s Hospital, Boston, MA

Dr. Bykov
Dr. Bykov

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

Response: Gabapentinoids (gabapentin and pregabalin) are increasingly utilized for postoperative analgesia. These are anticonvulsant drugs that are associated with sedation. Their use in the treatment of perioperative or postoperative pain is off-label, and recently FDA issued a warning about serious breathing problems associated with gabapentinoids in patients with other respiratory risk factors, including the use of opioids.

In this study, we focused on inpatient use of gabapentinoids and found that among patients who had major surgery and were treated with opioids, those who had gabapentinoids added to their therapy were twice as likely to experience opioid overdose and 70% more likely to experience respiratory complications that required the use of naloxone. The absolute risk of opioid-related adverse events was low (< 1%), although we could be underestimating the risks, given that the data on outcomes came from discharge forms and some hospitals may not have included these adverse events on them.

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Mindfulness-Based Stress Reduction for Chronic Pain in Breast Cancer Patients

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PainRelief.com Interview with:
Andra Smith, Ph.D.
Full Professor, School of Psychology
University of Ottawa, Ottawa, ON

Andra Smith, Ph.D. Full Professor, School of Psychology University of Ottawa, Ottawa, ON
Dr. Smith

PainRelief.com:  What is the background for this study?
Response: The process of going through breast cancer treatment is challenging enough on its own and can continue to impact cancer survivors long after treatment ends. One of the common side effects of breast cancer treatment is the development of chronic neuropathic pain (CNP), which for many women is debilitating and difficult to manage. Medications are not always effective and quality of life, cognitive abilities, and overall well-being can be reduced due to this pain. Knowing personally and from previous research how effective mindfulness can be for well-being, it made sense to introduce a mindfulness-based stress reduction program (MBSR) to these women going through chronic neuropathic pain due to breast cancer treatment. Mindfulness has occasionally been dismissed as a ‘fad’ so it was important to investigate the impact of an MBSR program with objective measures that could provide empirical evidence of its effects within this population. Dr. Poulin had the clinical resources and participants for the study while Dr. Smith had the imaging expertise. Together we performed a brain imaging (MRI/fMRI) study with women more than a year following treatment for breast cancer, suffering from chronic neuropathic pain. We scanned them all before and after either an MBSR program or usual care, assessing brain health, resting-state brain activity, and neurophysiological responses to emotional/pain-related words (Emotional Stroop task).    

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Withdrawal Symptoms Common in People Using Cannabis for Pain Relief

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PainRelief.com Interview with:
Lara Coughlin, Ph.D.
Assistant Professor | Addiction Center
Department of Psychiatry
University of Michigan

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

Response: In this study we followed people that were seeking certification for medical cannabis use for chronic pain over the course of two years. We assessed the prevalence and progression of cannabis withdrawal.

We found that most people experienced multiple withdrawal symptoms, such as craving cannabis, anxiety, and irritability, when they went without cannabis. People that used cannabis more frequently, used larger amounts, and reported smoking cannabis had more withdrawal symptoms. Over time, people that were younger were more likely to experience increasing withdrawal symptoms and people that vaped cannabis tended not to experience improvement in their withdrawal symptoms.  

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Why is Exercise Prescribed for Low Back Pain Relief?

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PainRelief.com Interview with:
Matthew Jones PhD, AEP
Lecturer
Department of Exercise Physiology, Faculty of Medicine
UNSW SYDNEY

Dr. Jones


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

Response: Bck pain is the leading cause of disability worldwide and is associated with significant individual and societal costs. Low back pain can significantly impact an individual’s ability to carry out day to day tasks. Clinical guidelines consistently recommend that people with low back pain take exercise, and there does not appear to be a type of exercise (e.g., walking, Pilates, lifting weights) that is better than another for reducing pain and improving function. Despite hundreds of studies of exercise in people with low back pain, researchers do not have a good idea of how it works. This is important, because if we know how something works, we can design more effective interventions to reduce the burden of low back pain. The aim of this review was to summarise why researchers think exercise helps people with chronic low back pain (i.e., pain persisting for longer than 3 months).

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Mindfulness Meditation for Migraine Pain Relief

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PainRelief.com Interview with:
Rebecca Erwin Wells, MD, MPH
Associate Professor, Department of Neurology
UCNS Certified Headache Specialist
Founder and Director of the Comprehensive Headache Program at Wake Forest Baptist
Wake Forest School of Medicine

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

  • Migraine is the second leading cause of disability worldwide.
  • Many patients with migraine stop medications because of side effects or ineffectiveness.
  • Many patients with migraine still use opioids despite recommendations against them for headache treatment. 
  • Mindfulness is helpful for many clinical pain conditions.
  • We conducted a pilot study of mindfulness for migraine that demonstrated benefit, so we conducted this larger randomized controlled trial to understand further potential benefit.
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Recorded Music plus Text During Anesthesia Reduced Need for Pain Medication

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PainRelief.com Interview with:
Prof. Dr. Ernil Hansen
Department of Anesthesiology
University Hospital Regensburg
Regensburg, Germany

Prof. Dr. Hansen

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

Response: It is becoming more and more clear that besides drugs and surgery it is communication that makes therapy effective. A meta-analysis we had conducted recently, suggested some beneficial effects of taped words played during surgery in older studies.

Our current study on 385 patients showed evidence that a text based on hypnotherapeutic principles an reduce postoperative pain and use of opioids. Pain within the first 24h after surgery decreased by 25%, opioid requirement by 34%. Six patients needed to be treated to save one patient from opioid exposure at all. High demand for analgesics was reduced by 41%. 

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5-Year Follow-Up of Open-Label Placebo Trial for Chronic Low Back Pain Relief

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PainRelief.com Interview with:
Claudia Carvalho, PhD
Instituto Universitário de Ciências Psicológicas
Social e da Vida
Lisbon, Portugal

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

Response:  Some clinical trials on chronic pain have shown placebo responses that rival those of commonly prescribed first-line therapies for low back pain (LBP).  However, prescribing placebos would pose ethical problems in clinical practice.  One solution to this problem is the use of open label placebos (OLP), which are presented to patients openly as pills without active ingredients, along with a rationale indicating that because of classical conditioning of relief with active medications, the pills themselves might reduce pain. OLP has been shown effective compared to treatment-as-usual for a number of clinical conditions, including chronic LBP.  Having conducted the first clinical trial on OLP on back pain, my colleagues and I wondered whether the effects were long-lasting. To answer that question, we conducted a five-year follow-up on the patients who had received OLP for their back pain.

In our original study, patients who took OLP pills for three weeks experienced greater reduction in back pain intensity and in back pain related disability than patients that simply continued their usual treatment. Additionally, after this phase of the trial, we offered OLP to participants  in the treatment as usual group) and they also reported a significant reductions in pain and disability, together with a spontaneous decrease in the use of pain medication by participants.

In our current follow-up, we found that patients who had taken OLP for three weeks had maintained their reductions in pain and disability 5 years later. In addition, pain medication usage was reduced by 49%. This follow-up study is currently in press (https://journals.lww.com/pain/Fulltext/9000/Open_label_placebo_for_chronic_low_back_pain__a.98186.aspx)

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