Real World Study Evaluates Medical Cannabis for Cancer Pain Relief

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PainRelief.com Interview with:
David (Dedi) Meiri PhD
Principal Investigato
Laboratory of Cancer Biology and Cannabinoid Research
Technion
Israel Institute of Technology

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

Response: We encountered numerous cancer patients that asked us whether medical cannabis treatment can benefit their health, however, while there is a lot of anecdotal evidence regarding the effectiveness of medical cannabis for pain, not much was known regarding its effectiveness in particular for the treatment of cancer-related pain; and there were no validated clinical studies. This motivated us to conduct an organized and thorough study that can serve patients and government ministries alike.

This study, which was conducted by Dr. Joshua Aviram as part of his postdoctoral fellowship, is the first to assess the possible benefits of medical cannabis for cancer-related pain in oncology patients, gathering information from right before they started the treatment and with repeated follow-ups for an extended period of time. Over a span of six months, we investigated the effectiveness and safety of medical cannabis treatment based on sound real-world evidence.

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Australian Study Finds Most Medical Cannabis Obtained Without Prescription

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PainRelief.com Interview with:
Janni Leung, PhD
National Health and Medical Research Council Emerging Leadership Fellow
National Centre for Youth Substance Use Research (NCYSUR)
The University of Queensland

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

Response: It is important to know the prevalence and source of medical cannabis use because non-prescribed use may put individuals at risk.

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Review of Lidocaine Infusions for Pain Relief from Chronic Migraine

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PainRelief.com Interview with:
Eric C. Schwenk MD
Anesthesiology
Sidney Kimmel Medical College
Thomas Jefferson University
Philadelphia, Pennsylvania

Dr. Schwent

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

Response: Patients with refractory chronic migraine (rCM) have typically failed all available medications and many times have nearly constant headache pain and in many cases disability. Aggressive treatment is indicated to provide relief and help break the cycle of pain.

Lidocaine infusions have been used for decades in various acute and chronic pain conditions, including complex regional pain syndrome and pain after surgery. At the Jefferson Headache Center lidocaine has been a mainstay of treatment for such patients for several decades but evidence supporting its benefits is scarce.

The main findings were that patients with rCM experienced acute relief at the end of the infusion and that some relief was sustained at 1 month, although the degree of pain relief faded over time. It was also well tolerated with nausea and vomiting occurring in 16.6% of patients and other side effects occurring less frequently.

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Chronic Pain: Sex Differences in Pain Relief from High vs Low Spinal Cord Stimulation

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PainRelief.com Interview with:
Imanuel Lerman MD MSc
Associate Professor 
Affiliate Electrical and Computer Engineering 
VA San Diego Healthcare System
Center for Stress and Mental Health
Center for Pain Medicine 
UC San Diego Health 
Qualcomm Institute 
California Institute for Telecommunications and Information Technology (Calit2)

Dr. Lerman

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

Response: Spinal Cord Stimulation (SCS) offers an implantable, non-pharmacologic treatment for patients with intractable chronic pain conditions.  There is extensive clinical literature that offers support for efficacy in chronic pain treatment for both Low frequency and High frequency based  spinal cord stimulation. While Low Frequency SCS has been heavily examined since its inception, High Frequency SCS paradigms have recently been clinically approved.

Emerging preclinical work also show sex may alter certain immunological pathways that contribute to chronic pain.  But to date few report have identified interactions between sex and SCS.  Therefore, we aimed to fill this knowledge gap through a single site (University of California San Diego), large (n=237) retrospective (2004–2020) analyses that compared SCS paradigm Low vs High Frequency SCS, efficacy (pain relief and opiate sparing effects) across sex.

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Racial and Ethnic Disparities in Use of Epidural Blood Patch for Pain Relief in Obstetric Patients

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PainRelief.com Interview with:
Allison Lee, MD, MS  [she/her/hers]
Associate Professor of Anesthesiology
Division of Obstetric Anesthesia
Officer of Diversity, Equity and Inclusion, Department of Anesthesiology
Medical Director of the Margaret Wood Center for Simulation and Education
Columbia University Medical Center
New York, NY 10032

Dr. Lee

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

Response: Racial and ethnic disparities in maternal health outcomes have been well documented but there has been limited research with respect to disparities specifically related to obstetric anesthesia care. We knew that among minority women, compared with non-Hispanic white women, there was evidence of:

  • Lower labor epidural rates, despite it being the most effective modality for pain relief.
  • Higher rates of general anesthesia for cesarean deliveries, which is associated with greater risks and complications (Anesthesiology. 2019 Jun;130(6):912-922.)
  • Worse management of pain after cesarean delivery

Given the importance of effective management of postdural puncture headache and in light of growing evidence of  complications if untreated (Anesth Analg. 2019 Nov;129(5):1328-1336.), we hypothesized that similar patterns with respect to inferior management of postdural puncture headache among minority women would be observed.

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Study Evaluates Long-Acting Bupivacaine for Pain Relief During Knee Replacement

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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. 

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Acetaminophen Label Changes Impact On Hospital Admissions for Overdoses

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PainRelief.com Interview with:
Tony Antoniou PhD
Department of Family and Community Medicine
Li Ka Shing Knowledge Institute
St. Michael’s Research Institute

Dr. Antoniou

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

Response: Acetaminophen is used by millions of people worldwide and included as an ingredient in hundreds of over the counter products for pain and the common cold. Accidentally taking more than the safe dose of the drug is therefore possible. This is important because taking too much acetaminopohen can lead to potentially serious and fatal liver injury.

In Canada, changes to acetaminophen product labels warning individuals of the risk of taking too much of the drug and letting consumers know that the product can take acetaminophen were made to try and prevent accidental overdoses. We studied whether these label changes had any impact on the number of people being hospitalized with accidental acetaminophen overdose over a 16-year period.

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Osteopathic Medicine Reviewed for Non-Specific Low Back Pain

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PainRelief.com Interview with:
Donatella Bagagiolo Osteopath D.O. BSc. (Hons) Ost.
Director of Research Department, Scuola Superiore di Osteopatia Italiana
Torino Italy

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

Response: Osteopathic medicine, depending on different legal and regulatory structures around the world, is a medical profession (e.g. USA), an allied health profession (e.g. UK) or a part of complementary and alternative medicine (e.g. Italy or France). Osteopathic medicine plays an important role primarily in musculoskeletal healthcare. In recent years, systematic reviews have been published to evaluate the clinical efficacy and safety of osteopathic medicine for conditions such as low back pain, neck pain and migraine. However, due to differences in methodologies and the quality of systematic reviews, no clear conclusions were achieved. The aim of our overview was to summarize the available clinical evidence on the efficacy and safety of osteopathic medicine for different conditions.

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Psychological Interventions For Non-Specific Chronic Low Back Pain

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PainRelief.com Interview with:

Ms Emma Ho | BAppSc(Phty)(Hons), PhD Candidate
The University of Sydney                                          
Faculty of Medicine and Health | Charles Perkins Centre Musculoskeletal Research Hub | Sydney NeuroMusculoskeletal Research Collaborative
Faculty of Medicine and Health, The Back Pain Research Team, Sydney Musculoskeletal Health, The Kolling Institute, School of Health Sciences

Emma Ho

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

Response: Adults with chronic low back pain (lasting for more than 12 weeks) not only experience physical disability but can also suffer psychological distress in the form of anxiety, depression, and fear avoidance (avoiding movement for fear of pain).

Clinical guidelines therefore consistently recommend a combination of exercise and psychosocial therapies for managing chronic low back pain. However, not much is known about the different types of psychological therapies available as well as their comparative effectiveness and safety, leaving doctors and patients often unclear about the best choice of treatment. Accordingly, the aim of our systematic review with network meta-analysis was to determine the comparative effectiveness and safety of psychological interventions for chronic non-specific low back pain.

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Pharmacists May Play An Important Role in Pain Management

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PainRelief.com Interview with:
Nathorn (Nui) Chaiyakunapruk PharmD, PhD
Professor, Department of Pharmacotherapy
University of Utah College of Pharmacy
Salt Lake City, UT 84112

Dr. Chaiyakunapruk

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

Response: Pain and pain-related diseases are the major causes of disability and disease burden worldwide. Over the last two decades, as the role of the pharmacist has expanded, pharmacist engagement in disease state management including pain management has been shown to improve clinical outcomes. Several systematic reviews have been conducted to date that assessed the impact of pharmacist interventions on pain management. However, the evidence on the effect of any type of pharmacist intervention, whether led by a pharmacist or in a supportive role, on pain intensity over time in individuals with pain of any etiology is currently inadequate. This study aims to fill that gap.

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