Jefferson DrapkinBS Research Associate Maimonides Medical Center Department of Emergency Medicine Brooklyn, New York
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Nebulized administration of ketamine has been studied in the areas of palliative care, therapy for asthma, and acute postoperative management of sore throat. To our knowledge, there is no literature regarding analgesic efficacy and safety of nebulized ketamine’s role in managing acute painful conditions in the emergency department (ED).
As all five patients had a decrease in pain from baseline to 120 min, this case series demonstrates that the inhalation route of ketamine delivery via breath-actuated nebulizer may have utility for managing pain in the ED.
PainRelief.com Interview with: Joseph V. Pergolizzi, Jr., M.D. Co-Founder and Chief Operating OfficerNEMA Research Inc.
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Chronic low back pain (CLBP) is a leading cause of disability.
Acetaminophen and nonsteroidal anti-inflammatory drugs are first-line analgesic options or mild CLBP; however, when certain patients with moderate to severe CLBP do not achieve adequate pain relief, opioids are considered as an add-on therapy. Unfortunately, most opioid analgesics have the potential for adverse effects, abuse, and diversion.
Buprenorphine buccal film (Belbuca®) is an opioid analgesic classified as a Schedule III controlled substance in the United States and is a partial μ-opioid receptor agonist.
Buprenorphine buccal film is a unique analgesic that is approved by the US Food and Drug Administration for use in patients with chronic pain severe enough to require daily, around-the-clock, long-term opioid treatment for whom alternative treatment options are inadequate.
Two pivotal phase 3 clinical trials (Study 307, Clinical Trial ID NCT01675167, and Study 308, Clinical Trial ID NCT01633944) established the efficacy and safety profiles of buprenorphine buccal film.
Charles H. Hennekens, M.D., Dr.P.H, FACPM, FACC Sir Richard Doll Professor and Senior Academic Advisor Charles E. Schmidt College of Medicine Florida Atlantic University
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: About 29 million Americans use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) to treat pain. Every year in the United States (US), NSAID use is attributed to approximately 100,000 hospitalizations and 17,000 deaths. In addition, the U.S. Food and Drug Administration recently strengthened its warning about risks of non-aspirin NSAIDs on heart attacks and strokes.
While each over the counter and prescription pain reliever has benefits and risks, deciding which to use is complicated for healthcare providers and their patients.
Ari J. IsaacsonMD Director of Clinical Research Clinical Associate Professor, Vascular Interventional Radiology University of North Carolina
PainRelief.com: What is the
background for this study?
Response: The current treatments for pain due to osteoarthritis of the knee that does not respond to medication or physical therapy include knee injections and knee replacement. However, some people are too young or unable to undergo knee replacement. Knee injections are often ineffective and need to repeated every few months. There is a need for a treatment option that can reliably relieve knee pain for a year or longer in patients who are not ready or able to undergo knee replacement.
PainRelief.com Interview with: Eric J. Roseen, DC, MSc Assistant Professsor, Department of Family Medicine Boston University School of Medicine and Boston Medical Center
Dr. Roseen
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Sleep disturbance and insomnia are common among people with chronic low back pain (cLBP). Previous research showed that 59% of people with cLBP experience poor sleep quality and 53% are diagnosed with insomnia disorder. Medication for both sleep and back pain can have serious side effects, and risk of opioid-related overdose and death increases with use of sleep medications. Given the serious risks of combining pain and sleep medications, we evaluated the use of nonpharmacologic approaches to manage sleep quality in adults with chronic low back pain.
Our randomized controlled trial included 320 adults with chronic low back pain from predominantly low-income racially diverse neighborhoods of Boston. At the beginning of the study, over 90 percent of participants with cLBP reported poor sleep quality. Participants were randomly assigned one of three different therapies for cLBP: physical therapy (PT), weekly yoga, or reading educational materials. Our previous research showed that yoga and PT are similarly effective for lowering pain and improving physical function, and reduced the need for pain medication. In this study, results for sleep improvements were compared over a 12-week intervention period and after 1 year of follow-up.
Tory R. Spindle, Ph.D. Postdoctoral Research Fellow Behavioral Pharmacology Research Unit Department of Psychiatry and Behavioral Sciences Johns Hopkins University School of Medicine
Dr. Spindle
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: Cannabis and hemp products that contain CBD as the primary constituent have become widely available in the U.S. and are often used for various therapeutic purposes. However, there is presently little research to understand how such products could impact drug testing for cannabis which is commonly conducted in workplace, criminal justice, and other settings.
Drug testing for cannabis targets a common metabolite of THC called THCCOOH; THC is the primary psychoactive component of cannabis. Our results suggest that single use of a product that contains pure CBD would not produce a positive result on a standard urine drug test. However, we found that 2 of 6 participants tested positive for cannabis after they used a CBD-dominant strain of cannabis that contained a very low concentration of THC: only 0.39% THC.
PainRelief.com Interview with: Alex Fauer, RN, OCN® Ph.D. Candidate University of Michigan School of Nursing
PainRelief.com: What are the main findings?
Response: Our primary finding of the paper is that the age-, sex-, and US region-adjusted percentage of adults who used a gabapentinoid increased from 2.34% to 5.60% from 2005 to 2015. The total number of gabapentinoid prescriptions filled among US adults diagnosed with cancer was approximately 1.19 million in 2005, but increased to 3.52 million in 2015.
We also found that adults aged 18-44 were the highest users of gabapentinoids.
Professor, University of California, San Diego Skaggs School of Pharmacy & Pharmaceutical Sciences San Diego Supercomputer Center
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: The background for this study was concern about unknown side effects of tramadol that became a popular treatment for chronic pain. With our informatics approach and access to millions of the FDA reports we were in a position to look for those adverse effects and we found that hyperglycemia (low blood sugar) is one of those concerns. There have been a few small-scale studies and case reports of tramadol use associated with hypoglycemia and hospitalizations related to it. The dramatic increase in tramadol prescription rates, especially in light of tighter control over hydocodone/acetaminophen (went from schedule III to II), warranted a larger scale postmarketing study of FDA FAERS reports.
As we compared the hypoglycemia side effect between different opioids we found that only one other drug, methadone (used to treat drug abuse and addiction), has a comparable association with hypoglycemia.
PainRelief.com: What should readers take away from your report?
Response:
Patients using tramadol should should be aware of
hypoglycemia symptoms such as shakiness, dizziness, sweating, hunger,
irritability, moodiness, anxiety/nervousness, and headache, or, in severe cases,
blurred vision, seizures or loss of consiousness. The same applies to
methadone, also known as Dolophine.
PainRelief.com: What recommendations do you have for future research as
a result of this work?
Response:
It may be beneficial to perform controlled studies to
confirm and understand this association. Our study looked at other drugs with
the known pharmacology of tramadol (mu-opioid agonism, serotonin/norepinephrine
re-uptake inhibition, and NMDAR antagonism), but did not find an association
with hypoglycemia with a specific class. Would be interesting to learn
more about additional/other pharmacology of tramadol and methadone behind the
etiology of hypoglycemia.
PainRelief.com: Is there anything else you would like to add?
Response:
We think that studies of this nature are beneficial since
rare side effects often go unnoticed in clinical trials due to a limited number
of participants. Additionally, hypoglycemia effects may often be attributed to
other medications and medical conditions, while tramadol or methadone were
unlikely to cause suspicion.
Any disclosures?
Non of the authors have any financial or non-financial conflicts
of interest to disclose.
Citation:
Tigran Makunts, Andrew U, Rabia S. Atayee, Ruben Abagyan. Retrospective analysis reveals significant
association of hypoglycemia with tramadol and methadone in contrast to other
opioids. Scientific Reports, 2019; 9 (1) DOI: 10.1038/s41598-019-48955-y
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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.
Dr Yousuf El Mokhallalati MD, MPH and PhD candidate Research Assistant, and PhD candidate Academic Unit of Palliative Care Leeds Institute of Health Sciences (LIHS) University of Leeds Leeds, UK
PainRelief.com: What is the
background for this study? What are the
main findings?
Response: We examined the factors
associated with good pain relief at before death, using data which was drawn
from responses to the National Bereavement Survey (VOICES) in England between
2011 and 2015, which asked families or close relatives to reflect on the quality
of care provided to a person who had died.
Just 10% of patients who
died of a non-cancerous disease received palliative care at home, compared to
63% of cancer patients.
The
study revealed that people who accessed palliative care at home were 2.7 times
more likely to have experienced good pain relief compared to those who did not
receive palliative care.
The
association between good pain relief and palliative care at home occurred
regardless of the type of disease that patients had, but access to palliative
care was not provided equally.
This research
shows that palliative care is associated with significant benefits to people
with every kind of progressive disease, but this is not reflected in the spread
of people that are being offered palliative care.
The study
also suggests that patients who had planned where they wanted to die are nearly
twice as likely to experience good pain relief compared to those who had not,
showing the value of planning ahead and coordinating the support of healthcare
professionals.
Only a quarter of patients were found to have recorded a preferred place of death. Cancer patients were nearly three times more likely to have a preference recorded compared to non-cancer patients (36.6% of cancer patients versus 13.1% of non-cancer patients).
PainRelief.com Interview with: Eve Ling-Khoo,MSc. OT Candidate, BSc. Hons Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
PainRelief.com: What is the
background for this study? What are the
main findings?
20%
of adults worldwide suffer from chronic pain which impacts all facets of
well-being.
Cognitive
behavioral therapy (CBT) is the current gold standard for psychological
intervention, but not everyone responds to it.
Mindfulness-based
stress reduction (MBSR) is an alternative with the potential to improve the
quality of life of patients with chronic pain.
The information on PainRelief.com is provided for educational purposes only, and is in no way intended to diagnose, endorese, 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. None of the content on PainRelief.com is warranted by the editors or owners of PainRelief.com or Eminent Domains Inc.
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