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.
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.
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.
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.
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.
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.
Dr. Shantha Ganesan MD Pain Medicine Specialist Kings County Hospital Center
David Kim, MD, PGY-2 SUNY Downstate Department of Anesthesiology
PainRelief.com: What is the background for this study? What are the main findings?
Response: The opioid epidemic is a serious national crisis that has detrimental impacts on both public health, and social and economic welfare. Therefore, any efforts to combat the opioid epidemic, including minimizing or weaning opioid prescriptions, and using other modes of analgesia when possible are undeniably necessary in this day and age. With the onset of Covid-19 pandemic, healthcare providers abruptly changed their care delivery. In-person clinic visits were changed to telemedicine, and elective cases were cancelled.
Due to a growing concern that chronic pain patients may have limited resources from this unprecedented time of social and economic shutdown, organizations such as American Medical Association and Drug Enforcement Administration have supported implementing measures to ensure these patients achieve adequate pain control by increasing access to pain medications, but at the cost of reducing barriers and restrictions to controlled substances. Given the cancellation of elective interventional pain management procedures and relaxed regulations on controlled substances during the Covid-19 pandemic, it is reasonable to suspect a dramatic increase in opioid prescription during this time.
PainRelief.com Interview with: Didem Bernard, Ph.D. Senior Economist Agency for Healthcare Research and Quality
PainRelief.com: What is the background for this study? What are the main findings?
Response: There had not been any studies on whether patient attitudes about health affect opioid use. A self-reliant health attitude is agreement with the following statements: “I do not need health insurance,” and “I can overcome illness without help from a medically trained person.”
We find that health-related attitudes affect both adults with and without chronic pain treatment similarly. Adults with self-reliant health attitudes are less likely to start and more likely to discontinue opioid use. Exercise is also associated with a higher probability of choosing no analgesic treatments over using opioids. Similarly, among adults who are using opioids for pain treatment, exercise is associated with a higher probability of discontinuing opioid use in the year following opioid initiation.
Board Certified Clinical Specialist in Orthopaedic Physical Therapy Certified Health Coach Faculty Development Resident Doctor of Physical Therapy Division Duke University School of Medicine
Dr. Rethorn
ainRelief.com: What is the background for this study? How was the coaching delivered? What types of pain were included in the study?
Response: The background for this study is that care for folks with persistent pain is complex and requires care that addresses the whole person. In line with this, health coaching may be an effective avenue for promoting healthy behaviors and helping patients to identify their personal values and goals related to persistent pain management.
PainRelief.com Interview with: Anton Pottegård DMSc PhD Professor (MScPharm, PhD, DMSc) Clinical Pharmacology and Pharmacy, Department of Public Health University of Southern Denmark Head of Research, Hospital Pharmacy Funen Odense University Hospital
PainRelief.com: What is the background for this study?
Response: Early in the COVID-19 pandemic, concerns were raised that use of the common painkiller ibuprofen – a so-called NSAID – to treat symptoms of COVID-19 might lead to more severe disease. This started with tweets from the French health minister and culminated with a warning issued by the WHO. This warning was later retracted, but naturally patients and physicians were concerned regarding the safety of ibuprofen. We therefore established a nationwide Danish collaboration between researchers and regulators and established a prospective cohort of all Danish patients that contracted COVID-19, including data on what prescription medicines they used. We used these data to evaluate whether users of ibuprofen or other NSAIDs on average had a more severe course of COVID-19 than those not using these drugs.
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