Concurrent Opioid and Benzodiazepine Prescriptions for Pain Relief Fall But Still Common

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PainRelief.com Interview with:
Kun Zhang PhD
Senior Service Fellow and Health Scientist
Opioid Overdose Prevention Health Systems Team
Division of Unintentional Injury Prevention
Centers for Disease Control and Prevention

Dr. Zhang

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

Response: When taken together by patients, opioids and benzodiazepines can result in synergistic respiratory depression which elevates overdose risk; however, these two medications have been commonly co-prescribed in the U.S.

Since 2016 there has been efforts to address the concurrent use of these two drugs, for example the 2016 FDA Boxed Warning and the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain.

Our study aimed at tracking and analyzing recent trends in concurrent use of these two medications using national level data.

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Barriers to Implementation of Patient Education in Inflammatory Arthritis

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PainRelief.com Interview with:
Mwidimi Ndosi PhD MSc BSc PGCert (Clin Ed) FHEA RN 
Sarah Bennet and Beth Jones
Associate Professor in Rheumatology Nursing
University of the West of England, Bristol  
Honorary Researcher
University Hospitals Bristol and Weston NHS Trust  

Dr. Ndosi

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

Response: Patient education is seen as an essential part of managing long-term conditions like inflammatory arthritis. Chronic inflammatory arthritis includes rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. We define patient education as a planned interactive learning process designed to support and enable people to manage their life with a disease and optimise their health and wellbeing.[1]

There are variations across Europe in the way patient education is delivered to people with inflammatory arthritis. In 2015, an international group of professionals and patients with inflammatory arthritis developed evidence-based recommendations for patient education [1]. This initiative was supported by the European Alliance of Associations for Rheumatology (EULAR), an organisation representing people with arthritis, health professionals in rheumatology and scientific societies of rheumatology in Europe.

In this study, we wanted to find out whether the recommendations were acceptable to patients and healthcare professionals. We also needed to know what helped people to follow these recommendations and what were barriers to putting them into practice. We surveyed health professionals in 20 countries in Europe, and 3 in Asia (India, Hong Kong and Japan) [2]

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Walking is Free – And It Might Help to Prevent Knee Pain

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PainRelief.com Interview with:
Grace H. Lo, MD MSc
Assistant Professor of Medicine at Baylor College of Medicine
Chief of Rheumatology and
Investigator at the Center for Innovations in Quality, Effectiveness and Safety
Michael E. DeBakey VA Medical Center, Houston, TX.

Grace Hsiao-Wei Lo
Dr. Grace Hsiao-Wei Lo

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

Response: To conduct this study, we used data from the Osteoarthritis Initiative, a research endeavor that has been funded by the NIH and pharma partners for many years.

Our study including people age 50 and older who have signs of osteoarthritis in their knees.

When we looked at those who did not have regular knee pain at the beginning of the study, those who walked for exercise were LESS likely to develop regular knee pain compared to those who do not walk.  

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Policymakers Can Mitigate Prescription Opioid Misuse Associated with Delayed Dispensing for Pain Relief after Procedures

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PainRelief.com Interview with:
Kao–Ping Chua, 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.

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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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