Category Archives: Pain-Relief

New Model Helps Clinicians Predict Which Patients Require Highest Doses of Opioids for Pain Relief

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PainRelief.com Interview with:
Dr. Mieke Soens, MD
Anesthesiology Specialist 
Brigham and Women’s Hospital

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

Response: Opioid use worldwide has doubled in the last two decades and several countries, including the US, are struggling with a real opioid epidemic. Higher opioid doses after surgery are associated with prolonged opioid use and misuse. For example, in a study of more than 30,000 patients undergoing minor surgery such as appendectomy or gallbladder surgery, the risk to become a chronic opioid user was around 6% compared to 0.4% in the non-surgical population.

Many of our colleagues have previously identified predictors associated with more severe pain and opioid use after surgery, however, to assess those predictors, they had to use lengthy questionnaires. This approach is very time-consuming and impractical for use in daily clinical practice. The machine learning models that we have developed can work quickly and in real-time prior to surgery to mine data from patient’s electronic medical records and without the need for cumbersome questionnaires, in order to selectively identify those patients who will need high doses of opioids after surgery.

This can help reduce postoperative opioid use, by allowing the care team to maximize non-opioid analgesic strategies in these patients. Examples of non-opioid strategies include nerve blocks and epidurals and different types of non-opioid medications. We know that these alternatives can be very costly and sometimes risky. Therefore, being able to target the right treatment to the right patient is important to not only to reduce opioid use, but also to ensure that patients receive the treatment that is right for them.

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Opioid Epidemic for Pain Relief Has Waned But is Not Over

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PainRelief.com Interview with:
Mario Moric M.S.
Department of Anesthesiology
Rush University Medical
Center Department of Anesthesiology

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

  • Prescription Pain Medicine (PPM) abuse has become a national problem and is now consider an epidemic. In 2012, health care providers wrote 259 million prescriptions for opioid pain medication; enough for every American adult to have a bottle of opioids. 
  • With the recent public information campaign about the epidemic and the possible addictive nature of opioid prescription pain medications, the abuse rates have declined.  We examined data from the National Survey on Drug Use and Health (NSDUH) public data derived from a national survey. 
  • We have raw data (actual reported rates of PPM abuse, see attached image) and weighted data (corrected for the sampling design).  Looking at the raw data you can see that abuse rates for lifetime use (highest line), past year use (middle red line) and past month use (bottom green line) are all more or less stable until 1998 after which we saw huge increase. From 1998 to 2004 the lifetime use increased 186%, the past year use increased 193% and the past month use increased 183%.  Then the decrease, from 2009 to 2018 the lifetime use decreased 72%, the past year use decreased 90% and the past month use decreased 185%.
  • Using the weighted data, the past year use decreases 26% and was statistically significant, indicating a real world decrease in prescription pain medication abuse.
Prescription Pain Medicine
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COVID-19 Protein Provides Pain Relief, Opening Up Targets for Future Pain Treatments

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PainRelief.com Interview with:
Rajesh Khanna, PhD
Professor of Pharmacology, Anesthesiology and Neuroscience
University of Arizona 
Tucson, AZ 85724

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

Response: SARS-COV-2 infection can be spread by asymptomatic, presymptomatic, and symptomatic carriers. Transmission of SARS-CoV-2 by asymptomatic or presymptomatic individuals may account for half of the spread, which may be why the virus has been so difficult to contain. The data from our study shows that the Spike protein, the major surface antigen of SARS-CoV-2, is analgesic. Therefore, an explanation for the unabated spread may be that asymptomatic or presymptomatic individuals do not experience the pain and discomfort that act as early warning signs of infection.

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Cognition in Adults Who Use Medical Marijuana for Chronic Pain Relief

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PainRelief.com Interview with:
Dr. Sharon R. Sznitman PhD and
Dr. Galit Weinstein, PhD
School of Public Health,
University of Haifa, Haifa, Israel

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

Response: Due to increased media attention related to the topic of medical cannabis and increasing public demand for the treatment, physicians often find themselves in situations where patients and caregivers request medical cannabis treatment. When this demand is from older patients, there is a dearth of studies of effectiveness and risk-benefit ratio as almost no studies have examined the potential therapeutic effects and potential risks of the treatment in this specific group. One of the main implications of cannabis use that researchers have grappled with is its long-term effect on cognitive function. It is well established that cannabis use has detrimental effects on the developing brain when consumed in early life, but detrimental effects of early-life cannabis use may not translate to use in older ages. Use of cannabis in old ages may have adverse effects on cognition but some evidence also exists showing beneficial effects.

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Mt. Sinai Study Identifies Lifestyle Changes That Provide Some Knee Pain Relief

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PainRelief.com Interview with:
Daniel A Charen MD
Leni and Peter May Department of Orthopaedic Surgery
Icahn School of Medicine at Mount Sinai, New York

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

Response: There is a well-established link between obesity and knee osteoarthritis, and recent research has implicated diabetes as a potential cause of cartilage degeneration. This study uses the National Health and Nutrition Examination Survey (NHANES) database to examine the association between knee pain and various metabolic factors.

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Are Invasive Procedures Effective for Chronic Pain Relief? A Systematic Review

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PainRelief.com Interview with:
Wayne B. Jonas, MD
Executive Director
Samueli Integrative Health Programs, H&S Ventures,
Alexandria, VA

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

Response: The search for non-drug approaches to chronic pain is a major recommendation in many recent guidelines for both pain management and reduction in the use of opioids. Surgical and invasive procedures are non-drug approaches often used for pain conditions like back pain and arthritis, so good evidence is needed to determine the safety and efficacy of these procedures. Properly done randomized, placebo-controlled trials are the best way (the gold standard) to get that evidence, so we did a thorough evaluation of such research, using standard systematic review and meta-analysis methods.

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Orthopedic Surgeon Discusses iovera Cold Therapy For Pain Relief from Knee Osteoarthritis

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PainRelief.com Interview with:
Dr. Sean McMillan DO
Chief of Orthopedics and Director of Orthopedic Sports Medicine
Lourdes Medical Center of Burlington County, Burlington, NJ
Assistant Professor of Orthopedic Surgery at Rowan University –
School of Osteopathic Medicine

Dr. McMillan discusses the iovera° system which is used to provide pain relief from knee osteoarthritis, using extreme cold therapy.


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

Response: I see many patients dealing with osteoarthritis (OA) pain, many of whom need total knee replacements. In fact, OA is the most common joint disorder in the United States and one of the primary reasons people seek knee replacement surgery. iovera° is a non-opioid, nonpharmacologic treatment that can alleviate knee pain by delivering extreme cold therapy (cryoanalgesia) to a targeted nerve. The iovera° treatment uses the body’s natural response to cold to treat nerves and immediately reduce pain for patients dealing with OA and/or surgical pain from knee replacement procedures. One treatment with the iovera° system can provide pain relief for up to 90 days.

Unaddressed knee pain can have many consequences such as increased discomfort, reduced mobility, and irreversible damage. This non-opioid treatment helps to stave off pain both prior to surgery and for postsurgical pain when surgery becomes necessary, making for a smoother recovery process with limited opioid use.

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Genetic Differences Distinguish Episodic Versus Chronic Migraine and May Open New Avenues of Pain Relief

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PainRelief.com Interview with:
Aliya Yakubova MD
OpenLab “Gene and Cell Technologies”
Institute of Fundamental Medicine, Kazan Federal University
Kazan, Russia

Dr. Yakubova

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

Response: Migraine is a common debilitating primary headache disorder with strong socio-economic effects. According to some estimates, migraine is the most costly neurological disease: for example, in the European Union, it costs more than 27 billion euros a year.

In this regard, chronic type of migraine (with more than 15 attacks per month for more than three months) is of special interest. Because of high prevalence and the burden of attacks, it is of great importance to improve diagnostic tools for patient stratification and choosing appropriate treatment strategies of migraine. For this purpose we investigated contribution of transient receptor potential vanilloid type 1 (TRPV1) receptors to migraine chronification. It is known that these receptors are directly involved in the disease pathogenesis being associated with the release of the key migraine pain mediator, the calcitonin gene – related peptide (CGRP). Moreover, recent studies have suggested that the non-synonymous TRPV1 single-nucleotide polymorphism (SNP) 1911A> G (rs8065080), resulting to the substitution of amino acids isoleucine to valine in the protein structure of receptor (Ile585Val), influences functional activity of these receptors in neuropathic pain syndromes. All this together was the starting point of our research in collaboration with colleagues from the University of Eastern Finland.

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Voltaren® Arthritis Pain Provided Meaningful Pain Relief in Knee Osteoarthritis

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PainRelief.com Interview with:

Jeffrey Fudin, B.S., Pharm.D., FCCP, FASHP
Diplomate, American Academy of Pain Management
Section Editor, Pain Medicine

Dr. Fudin

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

Response: Osteoarthritis (OA) affects over 14% of the United States population. As such it is important to establish effective, well-tolerated, and safe medication options. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) act locally and are strongly recommended for patients with knee osteoarthritis as a first line option prior to chronic oral NSAID use in an effort to minimize systemic exposure, as oral products, result in tremendously higher blood levels compared to their topical counterpart.

PainRelief.com: What are the main findings?

Response: Diclofenac sodium gel 1% (DSG 1%), a topical NSAID, provided better pain relief than non-drug vehicle alone for patients with knee osteoarthritis in 3 clinical trials. A post-hoc meta-analysis of these trials was conducted to determine the percentage of patients achieving a minimal clinically important improvement (MCII) in pain and other symptoms of OA to gain insight into the real world clinical impact of topical diclofenac for patients. The MCII is defined as the smallest improvement in symptoms viewed as clinically meaningful for patients. In short, the MCII represents an improvement of relevance in a clinical trial and the minimal meaningful change at an individual level.

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Wide Variation in Opioid Prescribing for Pain Relief Following Knee Arthroscopy

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PainRelief.com Interview with:
Benjamin Ukert PhD
Assistant Professor
Department of Health Policy and Management
Texas A&M

Mucio Kit Delgado, MD, MS
Department of Emergency Medicine
Perelman School of Medicine
University of Pennsylvania

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

Response: The opioid epidemic has received a lot of attention and many state policies have been passed to address excessive opioid prescribing and highlight the dangers of opioid use initiation for those who have never been exposed to opioids. We also now know that most patients prescribed opioids for post-operative pain have significant quantities of pills leftover. One study showed that after knee arthroscopy, 50% of patients took no opioids, and 90% took less than 5 pills (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190545/).

We thought to investigate whether overprescribing is still common, and asked the question whether we now observe low levels of prescribing following knee arthroscopy and whether there are differences in prescribing practices across states.

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