Category Archives: Pain-Relief

Cesarean Section: TAP Block with EXPAREL Provides Long-Acting Pain Relief and Reduces Opioid Use

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PainRelief.com Interview with:

Dr. Ashraf Habib, MB BCh
Chief of the Division of Women’s Anesthesia
Professor of Anesthesiology
Duke University, Durham, NC

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

Response:  Cesarean sections (C-sections) occur every day in the United States, with more than 1.2 million procedures in the US each year according to the CDC. Since postsurgical pain after C-sections can range from moderate to severe discomfort, it is important that this pain is managed effectively and safely. The amount of pain experienced and the way pain is treated can have an impact on a new mother’s postsurgical recovery. While opioids were once considered the standard treatment to manage pain after surgery, postsurgical opioid consumption can have a negative impact on a new mother’s recovery experience, causing unwanted side effects such as drowsiness, itching, nausea, vomiting, constipation and the risk of persistent use or dependence. In fact, research shows nearly nine in 10 mothers and mothers-to-be have concerns about taking opioids during and after childbirth, yet 51% of all C-section patients are still prescribed an opioid to manage postsurgical pain.

We recently published results from a Phase 4 study in Anesthesia and Analgesia that revealed the long-acting local anesthetic EXPAREL (bupivacaine liposome injectable suspension), when administered with bupivacaine as part of transversus abdominis plane (TAP) field block, provided a significant reduction in opioid consumption and a greater percentage of opioid-spared patients, with optimized pain control through 72 hours. This was a multicenter, randomized, double-blind study across 13 clinical sites in the United States, in patients undergoing elective C-section and receiving spinal anesthesia and a multimodal analgesic regimen. Patients were randomized to receive EXPAREL 266 mg plus bupivacaine HCl 50 mg or bupivacaine HCl 50 mg alone administered via TAP field block after delivery.

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Total Hip Replacement Can Be Safely Performed with Minimal Opioids for Pain Relief

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MedicalResearch.com Interview with:
Andrew Wickline MD FAAOS
New Hartford, NY 13413

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

Response: Joint replacement has long been synonymous with pain relief–but not until 6-12 weeks after surgery.  Many patients put off joint replacement due to fear and anxiety–particularly about the possible pain after surgery often seen in the first several months.  Opioids have long been the mainstay of controlling pain after surgery but are associated with significant side effects and risk for addiction and injury. 

Our study shows that with our comprehensive protocol, 97% of patients can have successful surgical recovery with little to no opioids being necessary to stay comfortable.  Additionally, it shows that 94% of patients can go home within 24 hours and 95% will likely need no post-operative therapy to recover.

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Business Model Can Help With Pain Relief Decisions After Surgery

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Dr. Schug

PainRelief.com Interview with:
Professor Stephan A Schug MD FANZCA FFPMANZCA EDPZ 
Emeritus Professor and Honorary Senior Research Fellow
Anaesthesiology and Pain Medicine
Medical School  University of Western Australia

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

Response: This paper is the result of applying a widely used tool in operations research, Multi-Criteria Decision Analysis (MCDA), to a medical problem, namely the use of parenteral analgesics in postoperative pain management. MCDA is a modelling approach which is aimed at achieving evidence-based decisions in settings of multiple conflicting criteria. It is commonly applied to decisions in politics and business; one of our co-authors is Lawrence D Phillips from the London School of Economics and Political Sciences, where he uses this methodology in these settings. However, there is increasing use of this methodology in medicine now, in particular in assessment of medicines with obviously conflicting criteria such as efficacy, adverse effects, safety and even price. The methodology has been applied to a number of medicine (eg psychoactive drugs) and considered by the European Medicines Agency (EMA).

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Hypnosis May Provide Some Pain Relief During Cardiac Procedure

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PainRelief.com Interview with:
Rodrigue Garcia, MD, MSc
Consultant cardiologist and electrophysiologist
Centre Hospitalier Universitaire Poitiers
France

Rodrigue Garcia, MD, MSc Consultant cardiologist and electrophysiologist Centre Hospitalier Universitaire Poitiers France

PainRelief.com:  What is the background for this study?  How was the hypnosis performed?

Response: Atrial flutter ablation is often very painful and requires important doses of opioids to alleviate the patients. Alternatives techniques such as hypnosis are routinely used in our lab but there was no scientific evidence of its utility.

Hypnosis was performed by a nurse who had a training delivered by the French Association of Hypnosis. The Ericksonian method was the first approach.

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ACP Recommends Non-Pharmacologic Treatments for Pain Relief From Acute Non–Low Back, Musculoskeletal Injuries

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PainRelief.com Interview with:
Timothy Wilt, MD, MPH
Chair ACP Clinical Guidelines Committee
Professor of Medicine
Minneapolis VA Center for Care Delivery and Outcomes Research.

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

Response: Acute non-low back musculoskeletal pain is common, disabling and costly. Most are treated in outpatient settings. Numerous pharmacologic and nonpharmacologic treatment options exist but there is uncertainty of their benefits, harms and costs. Additionally, opioid prescriptions are common for acute musculoskeletal injuries but have harms and can lead to chronic opioid use including dependence and overdose. ACP and AAFP developed these evidence based guidelines to assist clinicians in providing the highest quality care to their patients by considering information on benefits, harms and costs alongside patient values and preferences. Our main recommendations are as follows:

1)      ACP and AAFP recommend that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with topical nonsteroidal anti-inflammatory drugs (NSAIDs) with or without menthol gel as first-line therapy to reduce or relieve symptoms, including pain; improve physical function; and improve the patient’s treatment satisfaction.

2)      ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with oral NSAIDs to reduce or relieve symptoms, including pain, and to improve physical function, or with oral acetaminophen to reduce pain.

3)      ACP and AAFP suggest that clinicians treat patients with acute pain from non–low back, musculoskeletal injuries with specific acupressure to reduce pain and improve physical function, or with transcutaneous electrical nerve stimulation to reduce pain.

4)      ACP and AAFP suggest against clinicians treating patients with acute pain from non–low back, musculoskeletal injuries with opioids, including tramadol.

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Green Light Exposure May Provide Pain Relief and Reduce Need for Opioids

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PainRelief.com Interview with:

Padma Gulur MD
Professor of Anesthesiology and Population Health
Executive Vice Chair, Duke Anesthesiology 
Director, Pain Management Strategy and Opioid Surveillance
Duke University Health System

Padma Gulur MD Professor of Anesthesiology and Population Health Executive Vice Chair, Duke Anesthesiology Director, Pain Management Strategy and Opioid Surveillance Duke University Health System

PainRelief.com:  What is the background for this study?  How is the light administered? Might your findings help explain why green is widely considered a ‘calming’ color?

Response: Pain management continues to be challenging given the limited options for pain relief and the significant continued reliance on opioid medications as a primary mode of pain relief which has lead to the prescription opioid epidemic facing the country. Opioid exposure during clinical care is a key risk factor for subsequent misuse, and the probability of prolonged use scales with both dose and duration of opioid exposure. Minimizing opioid exposures reduces misuse risk. To do so while still effectively treating pain relies on opioid sparing multimodal pain relief strategies. In practice, this manifests as polypharmacy or the use of multiple medication classes. However most medications come with a significant side effect burden. Non-pharmacological options remain limited in efficacy or are difficult to integrate into clinical care. Recent pre-clinical findings have demonstrated robust pain relief in response to exposure to green light. These effects occurred both through the addition of green illuminating light in the environment and through green-biased filtration of visualized ambient light. 

We are conducting a pilot trial of exposure to green light for pain relief in paients that have recently undergone surgery to understand its effect on acute pain and to study its effect on chronic pain we are conducting the study in fibromyalgia patients. Our goal is to evaluate the feasibility and efficacy of eyeglasses-based colored light therapy. Recruitment for the acute arm of the study is complete. The chronic arm of the study is currently recruiting.

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Selenium Level Can Affect Liver Toxicity When Acetaminophen is Used for Pain Relief

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PainRelief.com Interview with:

Dr Charareh Pourzand PhD/DSc, FHEA, FRSB
Reader in Biopharmaceutics
Medicines Design Theme Leader
Head of UVA Photobiology, Iron & Oxidative stress group
Department of Pharmacy & Pharmacology
Centre for Therapeutic Innovation
University of Bath, Bath, United Kingdom



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

Response: It is recognized that acetaminophen (also known as paracetamol), a medication that is globally used for fever and pain, can cause acute liver damage when taken at higher level than the recommended dose.

This study demonstrated that acetaminophen can decrease the mouse liver’s antioxidant capacity by decreasing both the level of thioredoxin reductase (a selenoprotein and antioxidant enzyme) activity and glutathione (GSH, an antioxidant molecule) content in a dose- and time-dependent manner. These decreases also correlated with the extent of the liver damage exerted by acetaminophen. In addition, both mild-deprivations in selenium or excess selenium supplementation diets increased the extent of liver injury compared with mice with normal dietary selenium levels.  

In acetaminophen-treated mice, animals reared on selenium-deficient and excess selenium-supplemented diets also exhibited an increase in the oxidation state of the thioredoxin reductase-mediated system in subcellular compartments of the hepatocytes, notably in mitochondria which is the energy factory of the organism.

These observations revealed how the alteration of the function of the main antioxidant thioredoxin and GSH systems by acetaminophen is linked to hepatotoxicity.  Moreover it became apparent that the maintenance of the redox environment by thiols is a crucial determinant for the extent of acetaminophen-induced liver toxicity. Finally our study revealed the importance of dietary selenium level and the selenoproteins activity in protecting mice against the liver failure that can occur in acetaminophen overdose.

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Virus-Delivered Gene Therapy Provides Hope for Neuropathic Pain Relief

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PainRelief.com Interview with:
Sujeong Kim, PhD
Institute of BioInnovation Research, Kolon Life Science
Kolon One&Only Tower
Seoul Korea

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

Response: Neuropathic pain (NP) results from a lesion or disease affecting the somatosensory system, according to the International Association (IASP) for the Study of Pain. NP is difficult to treat and drastically influences an individual’s quality of life. Current treatment for NP aims to relieve pain and maintain patient function but does not address the etiological causes or alter the course of the condition. The causes of NP are many and varied in their scope, such as nerve injury, neuroinflammation, and abnormal pain signal transmission. NP has a multifactorial pathogenesis and their pathophysiology is the results of a very complex series of cross-linked pathway. There are limitations in treating pathogenesis by targeting only one path, so simultaneous targeting of multiple elements in NP is crucial for the treatment of the disease. Effective and disease-modifying options for NP treatment are urgently needed. We developed an AAV-based gene therapy, KLS-2031 (developed by KolonLifeScience Inc), for the expression of three therapeutic genes (encoding glutamate decarboxylase 65 (GAD65), glial cell-derived neurotrophic factor (GDNF), and interleukin 10 (IL-10)) to achieve the effective and long-lasting relief of NP.

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Can Placebos Be Effective Even If We Know It’s Not a ‘Real’ Drug?

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pain relief placebos

Darwin A. Guevarra, Ph.D.
Postdoctoral Fellow
Michigan State University

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

Response: Placebos are these inactive treatments that often work because people believe they are taking a real treatment. For the most part, they have real beneficial effects. However, there’s a utility-ethical issue when it comes to placebos. On one hand, they reliably work in managing daily nonclinical nuisance like emotional distress and even a host of clinical ailments like pain and depression. But, it seems like you have to lie to people that they’re taking a real treatment in order to get placebos to work. As it turns out though, there’s over a dozen studies showing that placebos can still work even when people are fully aware they are taking them. These studies educate participants about the placebo effects, how they work, and how they can probably still work even when people know they are taking one. This really opens up the possibility of ethically harnessing the beneficial effects of placebos. But there’s one glaring issue. These studies that found positive effects of non-deceptive placebos only show it with self-report and no studies show beneficial effects on biological measures. This casts some doubt on whether these self-reported beneficial effects are real.

Our study wanted to test if we can observe non-deceptive placebo effects on objective biological markers. In this case, we used a neural measure called the late positive potential that can track emotional distress. We find that non-deceptive placebos do reduce self-reported, but more importantly, neural measures of emotional distress.

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