“Empowered Relief” Program Equips Patients With Effective Pain Relief Skills

PainRelief.com Interview with:
Beth Darnall, PhD

Director, Stanford Pain Relief Innovations Lab
Associate Professor, Stanford University School of Medicine
Department of Anesthesiology, Perioperative and Pain Medicine
Psychiatry and Behavioral Sciences (by courtesy)
Wu Tsai Neurosciences Institute (affiliate faculty)
Palo Alto, CA 94304

Dr. Darnall

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

Best pain care integrates patient education and tools to help them manage pain and reduce their symptoms1. Multi-session psychological or “behavioral” pain treatment approaches, such as 8-session cognitive behavioral therapy (CBT), are effective for equipping people with pain management skills. However, our prior research showed that patient access to these treatments is often poor, in part due to the costs and time burdens (e.g., up to 16 hours of treatment time).2

Findings from our study suggest that a one-time 2-hour pain relief skills class (“Empowered Relief”) was non-inferior to 8-session CBT for reducing multiple symptoms, including pain catastrophizing, pain intensity, and pain interference at 3 months post-treatment. We also found the single-session pain class imparted substantial reductions for pain bothersome, sleep disturbance, anxiety, fatigue and depression.

Continue reading

Including a Body Map Can Help Clinicians Manage Chronic Pain

PainRelief.com Interview with:
Ben Alter, MD, PhD
Assistant Professor
Director, Translational Pain Research
Division of Pain Medicine
Department of Anesthesiology and Perioperative Medicine
University of Pittsburgh Medical Center

Dr. Ben Alter

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

Response: In the clinical environment, I am often asking patients where their pain is.  There is a large amount of research establishing that widespread or “all-over” pain is difficult to manage and impacts nearly every aspect of a patient’s life. In fact, a tally of body areas is involved with the diagnosis of fibromyalgia, although this is not the only diagnostic criteria. What wasn’t clear to us was whether patterns of pain across the body also impacted important facets of the pain experience.  

Continue reading

Back Pain: SelfBACK app To Help Patients Find Pain Relief From Self-Managed Program

PainRelief.com Interview with:
Louise Fleng Sandal PhD
Adjunkt, Institut for Idræt og Biomekanik
SDU University of Southern Denmark

Dr. Sandal

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

Response: Low back pain is a globally prevalent condition with a high economic cost. Many people seek help with primary care from their general practitioner, physiotherapist or chiropractor. Evidence-based guidelines on first line treatment include learning to self-manage, staying active, exercising and learning about the condition. However, many find this difficult without advice and support, but primary care physicians often lack the time and resources to support self-management.

Digital solutions, such as smartphone technology, utilizing artificial intelligence can be used to tailor self-management support to the individual and be available at the individuals convenience.

Continue reading

Telehealth for Pain Care Broadens Access to Treatment for Veterans

PainRelief.com Interview with:
Jessica Chen, Ph.D. (pronouns: she/her)

Jessica-Chen
Dr. Chen

Clinical Psychologist | VA Puget Sound, Seattle
Staff Psychologist | TelePain Clinic | VISN 20 Pain Medicine & Functional Restoration Center
Core Investigator | Health Services Research & Development | Seattle-Denver Center of Innovation
Assistant Professor | Department of Psychiatry & Behavioral Sciences University of Washington School of Medicine
Seattle, WA 98108

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

Response: Chronic pain affects two-thirds of U.S. military veterans, and nearly 10% of veterans report severe pain that leads to significant distress or impairment. Within the Veterans Health Administration (VHA), interdisciplinary pain management has been the standard of care for high-impact, complex chronic pain, but rural patients are less likely to receive these services.

Telehealth provides an opportunity to address problems with accessing care in rural communities. In 2018, VA Puget Sound launched a regional pain telehealth program, TelePain, to bring interdisciplinary pain care using video telehealth to rural veterans in the Northwest.  

In this study, we examined the impact of implementing TelePain on access to pain care among rural patients living in Washington state from 2015-2019 and compared their access to urban patients. All patients had moderate to severe chronic pain, and we included patients with any type of pain (e.g., back, neck, migraines, fibromyalgia, etc.). This study is a retrospective cohort analysis of VA data.

Continue reading

Migraine: Remote Electrical Neuromodulation For Pain Relief in Adolescents

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.

Continue reading

Multimodal Analgesia For Pain Relief After Joint Replacement

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.

Continue reading

Runners: Leaning Forward Increases Force on Hip Extensors

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.

Continue reading

Prescription Opioids for Pain Relief in Youth Decreased in Recent Years

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

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

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?

ResponseOur 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.