PainRelief.com Interview with: Matthew Johnson, D.P.M. Assistant Professor Department of Orthopaedic Surgery University of Texas Southwestern Medical Center
PainRelief.com: What is the background for this study?
Response: There is a paucity of literature attempting to characterize risk factors for nonunion of the Lapidus bunionectomy.
PainRelief.com: Would you briefly describe what is meant by a bunion?
Bunion with cornDermNet NZ image
Response: Bunions are a chronic painful bump that forms on the base of the big toe when the long metatarsal bone shifts toward the inside of the foot and the phalanx bones of the big toe angle toward the second toe.
PainRelief.com Interview with: Prof. Eran Ben-Arye MD Co-founder and director of the Unit of Complementary and Traditional Medicine Department of Family Medicine, Haifa Director of the Integrative Oncology Program within the Haifa and Western Galilee Oncology Service, Lin Medical Center, Clalit Health Services Chairperson of the Israel Society for Complementary Medicine of the Israel Medical Association
Prof. Ben-Arye
PainRelief.com: What is the background for this study?
Response: The study was part of an initiative whose stated goal was providing continuity of integrative oncology care to patients with gynecology cancer. Over the past 14 years we have been offering patients undergoing chemotherapy with integrative oncology treatments without charge, helping improve their quality of life and increasing their adherence to the conventional oncology treatment protocol.
The research presented in the current paper examined the introduction of the integrative treatment from as early as the time of cancer diagnosis and throughout the pre-surgical, surgical and post-surgical inpatient setting. The integrative process was a collaborative effort, taking place together with a team of surgeons, anesthesiologists and nurses throughout all stages of peri-operative care of the gynecology oncology patient.
PainRelief.com Interview with: Nicole Simunovic, MSc On behalf of the NO PAin Principal Investigators
PainRelief.com: What is the background for this study?
Response: Orthopaedic surgeons prescribe more opioids than any other type of surgeon in North America. Opioids have the potential to be highly addictive and can cause serious harm or even death if taken in excess. The goal of our clinical study was to determine if an opioid sparing approach to postoperative pain management was safe and effective in patients undergoing arthroscopic knee and shoulder surgery.
PainRelief.com Interview with: Kao–PingChua, MD, PhD Department of Pediatrics Susan B. Meister Child Health Evaluation and Research Center University of Michigan Medical School Department of Health Management and Policy University of Michigan School of Public Health, Ann Arbor
PainRelief.com: What is the background for this study?
Response: Opioid prescriptions written by dentists and surgeons are almost always written for the immediate relief of acute pain after procedures. However, current federal and state laws allow these prescriptions to be dispensed well after the time that they are written. When this occurs, that could be a potential sign that the prescription was used in a time frame or for a reason other than intended by the prescriber, both of which are forms of prescription opioid misuse.
PainRelief.com Interview with: Prof. Hemant G. Pandit, DPhil Leeds Institute of Rheumatic and Musculoskeletal Medicine Chapel Allerton Hospital, University of Leeds Leeds, United Kingdom
Prof. Pandit
PainRelief.com: What is the background for this study?
Response: Knee replacement is highly successful for treating severe arthritis. There are 100,000 people who undergo knee replacement surgery every year in the UK, with numbers set to rise significantly in future. It remains however a painful procedure with nearly half of patients reporting severe pain post-operatively. Currently pain control is provided by injecting a local anaesthetic of bupivacaine hydrochloride around the knee during surgery providing good pain relief for 12 to 24 hours. However, patients typically experienced the worst pain the next morning when they are encouraged to bend their knee and get out of bed.
Liposomal bupivacaine is a local anaesthetic preparation which can provide sustained release of pain relief medication over a longer period of time (up to 72 hours). The drug is costly and is used in routine clinical practice in the USA with previous studies showing varying results with the use of LB. We therefore (researchers at the Universities of Oxford and Leeds) developed the SPAARK (Study of Peri-Articular Anaesthetic for Replacement of the Knee) Trial, to test whether liposomal bupivacaine would be more effective at managing the pain compared to current treatments in patients undergoing a knee replacement.
PainRelief.com Interview with: Juan Ignacio, Teves Agustin, Garcia-Mansilla Italian Hospital of Buenos Aires
PainRelief.com: What is the background for this study?
Response: It is well known that the increased life expectancy of the general population leads to an increase in the number of prosthetic replacement surgeries in the years to come. A concern of patients who consult for this type of procedure is whether age alone is a risk factor for this surgery and the literature is not conclusive about whether age or comorbidities are more important in postoperative results.
For this reason, we decided to compare two series of patients, some older than 80 years and others younger, to determine whether or not age influences the result of total knee replacement.
PainRelief.com Interview with: Dr. Mohamad Bydon MD Professor of Neurosurgery Mayo Clinic Rochester, Minnesota
:Dr. Bydon MD
PainRelief.com: What is the background for this study?
Response: Patients presenting with back or leg pain due to degenerative lumbar spine disease often undergo spinal fusion to mitigate the symptoms and halt the progression of the disease.
PainRelief.com: What are the main findings?
Minimally invasive surgery (MIS) in the lumbar spine encompasses a variety of techniques, such as percutaneous screw placement and operation via tubular retractors, and aims to limit the distortion of patients’ anatomy as much as possible. Eventually, compared to open fusion, MIS fusion is associated with decreased muscle destruction, incision size, and time-to-mobilization.
PainRelief.com Interview with: Deepak Kumar, PT, PhD Assistant Professor, Physical Therapy Assistant Professor, BU School of Medicine Director, Movement & Applied Imaging Lab
Dr. Kumar
PainRelief.com: What is the background for this study? What are the main findings?
Response: We investigated the association of physical therapy interventions with long-term opioid use in people who undergo total knee replacement surgery. For people with advanced osteoarthritis, total knee replacement is the only option. The number of total knee replacement surgeries has been increasing and is expected to rise exponentially over the next few years with an aging population and rising rates of obesity. However, up to a third of patients continue to experience knee pain after this surgery. Also, a significant proportion of people become long-term opioid users after total knee replacement. Reliance on opioids may reflect a failure of pain management in these patients. Given that physical therapy interventions are known to be effective at managing pain due to knee osteoarthritis, we wanted to study whether physical therapy before or after surgery may reduce the likelihood of long-term opioid use.
We used real-world data from insurance claims for this study. In our cohort of about 67,000 patients who underwent knee replacement between 2001-2016, we observed that, receiving physical therapy within 90 days before surgery or outpatient physical therapy within 90 days after surgery were both related to lower likelihood of long-term opioid use later. We also observed that initiating outpatient physical therapy within 30 days and 6 or more sessions of physical therapy were associated with reduced likelihood of long-term opioid use compared to later initiation or fewer PT sessions, respectively. However, we did not see an association between type of physical therapy. i.e., active (e.g., exercsise) vs. passive (e.g., TENS) and long-term opioid use.
Importantly, most of our findings were consistent for people who had or had not used opioids previously. We also were able to account of a larger number of potential factors that could confound these associations because of the large sample size. However, there are limitations to our work. Since we only had access to insurance claims data but not to health records, we are unable to make any inferences about association of physical therapy with pain or quality of life, etc.
PainRelief.com Interview with: Kanu M. Okike, MD Orthopedic Surgeon The Hawaii Permanente Medical Group
PainRelief.com: What is the background for this study? What are the main findings?
Response:Hip corticosteroid injections are a common treatment for osteoarthritis and other hip conditions. Recently, isolated case reports have raised the question of whether hip corticosteroid injections could be associated with rapid progression of the arthritis process – a condition known as rapidly destructive hip disease (RDHD).
Joseph Albert Karam, MD Assistant Professor of Clinical Orthopaedic Surgery Associate Program Director, Orthopaedic Surgery Residency The University of Illinois at Chicago
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.
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