Caution Should Be Taken with Hip Steroid Injections For Arthritis Pain Relief

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).

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Pain Relief Study of Low Carb Ketogenic Diet

PainRelief.com Interview with:
Rowena Field

B.App.Sc (phty) M.Physio. APAM
Physiotherapist/Director
PhD research candidate Sydney University
STEPP (solutions tools and education for persistent pain)

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

Response: Chronic pain is a difficult problem to treat because it is multifactorial, driven by the brain continuing to arrive at the conclusion that protection is required. Turning up the sensitivity in the nervous system results in ongoing pain as a protector even though there is no new tissue damage. Other protection mechanisms such as increased inflammation, and increased sympathetic ‘fight or flight’ also occur.

Chronic pain becomes part of a whole system protective response, so looking at other treatment options that alter the system (such as diet) are useful additions to pain management. A ketogenic diet restricts carbohydrate to below 50g/day producing ketones for energy from fat. It has been used to treat epilepsy over the last two centuries and successfully reduces nervous system excitability. Many of the drugs used for chronic pain (such as Lyrica) are also anti-epileptic medications, suggesting common pathways. As well as these impacts on the nervous system, pre-clinical research has also shown ketones to be signalling molecules that reduce inflammation.

Combined with the clinical reports that pain reduction occurred when people were on ketogenic diets, it seemed reasonable to test the diet specifically in a chronic pain population.

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Switching to Buprenorphine Might Provide Pain Relief for Poorly Controlled Pain

PainRelief.com Interview with:
Victoria D. Powell, MD, FACP
Clinical Lecturer – Geriatric and Palliative Medicine
University of Michigan
Staff Physician, Palliative Care
LTC Charles S. Kettles VA Medical Center
Ann Arbor, MI

Dr. Powell

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

Response: People with chronic pain who use long-term opioids face a number of health risks, and often do not have optimally controlled pain.

Buprenorphine acts on the opioid receptor with a different effect than drugs like morphine or oxycodone, and as a result is less associated with the risks of long-term opioid use, such as accidental overdose. While buprenorphine has been successfully used in patients with opioid use disorder for several years, certain experts have proposed using buprenorphine for pain management in people with chronic pain. We found low quality evidence supporting pain control that may be superior to traditional opioids, but much more research is needed to confirm.

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Knee Arthritis: Racial Differences in Treatment Patterns and Health Care Expenditures

PainRelief.com Interview with:
Stuart L. Silverman MD FACP FACR
Clinical Professor of Medicine, Cedars-Sinai Medical Center and UCLA School of Medicine
Medical Director, OMC Clinical Research Center
Beverly Hills, CA 90211

Dr. Silverman

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

Response: As a practicing rheumatologist, I am aware that prior studies have shown variation in medical care, pain management and treatment with opioids by race and social economic status.  Suboptimal treatment of pain in patients with osteoarthritis (OA) may also disproportionately burden racial minorities and Medicaid recipients. 

Studies have shown that African Americans are nearly 1.5 times as likely to have symptomatic knee OA than White patients even when adjusting for other factors.  Similarly, they also have a higher prevalence of symptomatic and radiographic hip OA.  Analyses of Medicare data has shown evidence of persistent racial disparities for joint arthroplasty usage and surgical outcomes.

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Medical Cannabis May Be Helpful For Pain Relief in a Minority of People with Chronic Pain, But Will Not Be Effective For Most

PainRelief.com Interview with:
JASON BUSSE DC, PhD
Associate Professor
Associate Director
Michael G. DeGroote Centre for Medicinal Cannabis Research
McMaster University Medical Centre
Ontario, Canada

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

Response: Our focused clinical practice guideline was informed by 4 systematic reviews exploring benefits and harms of medical cannabis for chronic pain, the potential for cannabis to help people who live with pain to reduce their use of opioids, and patients values & preferences regarding medical cannabis for chronic pain. We found that non-inhaled medical cannabis provided small to very small improvements in pain relief, physical functioning and sleep quality compared to placebo, but did not improve mental functioning, role functioning or social functioning. Use of medical cannabis, versus placebo, also caused small increases in the risk of several transient, moderate, side effects, such as impaired attention, nausea, and drowsiness, and a larger increase in the risk of dizziness.

There was insufficient evidence to inform the risk of serious adverse events, such as motor vehicle accidents, cannabis use disorder (addiction), or suicide. We also found that patients’ attitudes towards medical cannabis show considerable variation, meaning that when presented with the same evidence different patients are likely to make different decisions about embarking on a trial of medical cannabis. Due to the close balance between modest benefits and harms, and high variability among patients’ attitudes, we made a weak recommendation to consider a trial of medical cannabis for people living with chronic pain who had not achieved sufficient relief with standard care.

A weak recommendation means that clinicians should provide chronic pain patients with the evidence for benefits and harms and help them to make a decision consistent with their patient’s values and preferences.

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Physicians Differently Prescribe Pain Relief Medications to White and Minority Patients

PainRelief.com Interview with:
Dan P. Ly M.D., M.P.P., Ph.D.
Division of General Internal Medicine and Health Services Research
David Geffen School of Medicine
University of California, Los Angeles

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

Response: We know that minority patients were less likely to receive opioids than white patients, but this could have been due to minority patients seeing lower opioid-prescribing physicians. As far as I could tell, nobody had been able to examine whether the same physician prescribed opioids differently to their minority patients.

I find that this is the case: the same physician was less likely to prescribe opioids to their minority patients with new low back pain, and instead was more likely to prescribe NSAIDs to their minority patients. And unfortunately, this differential prescribing may have had the consequence of leading to more chronic opioid use in white patients.  

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Medlab Clinical Developing New Buccal Spray for Chronic Cancer Pain Relief

PainRelief.com Interview with:
Dr.  Jeremy Henson
Director of Medical Affairs
Medlab Clinical Ltd

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

Response: THC and CBD combination medicines have the potential to provide a non-opioid option for chronic pain that does not have the GIT or respiratory adverse reactions of opioids and allows better cognitive functioning.

Delivery across the oro-buccal membrane appears to be best method of administration of cannabinoids for chronic pain. Oro-buccal delivery has pharmacokinetics appropriate for 6-8 hourly maintenance dosing and avoids first pass metabolism and the slow erratic onset of ingestion; and the high serum THC peaks, frequent redosing and toxic oxidation products of vaping.

The problems with using a 50% ethanol vehicle to deliver cannabinoids across the oro-buccal membrane include local irritation, incomplete absorption and significant systemic ethanol levels. These issues could be solved by using a micellular nanoparticle to solubilise the cannabinoids and deliver them across the oro-buccal mucous membrane.

This study was a first in human study of a micellular nanoparticle formulation of 1:1 THC and CBD delivered as an oro-buccal spray for chronic cancer pain.

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Virtual Reality Can Provide Pain Relief for Children Getting IV Catheters

PainRelief.com Interview with:
Dr. Jeffrey I. Gold PhD
Director Emeritus of the Pediatric Pain Medicine Clinic
Children’s Hospital Los Angeles and Investigator
The Saban Research Institute
Children’s Hospital Los Angeles

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

Response: Virtual Reality or digital therapeutics can have a profound impact on mitigating pain, anxiety, and distress associated with routine painful medical procedures, such as blood draw and IV placement. 

PainRelief.com:  What are the main findings? Would you explain what is meant by “triangulation of data”?

Response: Virtual Reality significantly reduces pain and anxiety in children undergoing PIVC placement compared to standard of care in two pediatric medical settings (radiology and the infusion center). The triangulation of data refers to collecting data on the patient, his/her caregiver, and the healthcare provider to examine the impact of the intervention from three different perspectives.

The current study demonstrated that an effective intervention for the patient can have a positive impact (ripple effect) on the caregiver and the healthcare provider, creating a more relaxed, calm, and less distressing medical experience.

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Study Identifies Three Patterns of Medical Cannabis Use for Pain

Dr. Deepika Slawek,

PainRelief.com Interview with:
Deepika Slawek, MD, MS, MPH 
(she/hers)
Assistant Professor of Medicine, Division of General Internal Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY 10467

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

Response: Medical cannabis has become increasingly available in the United States over the past 25 years and is commonly used for the management of pain. Little is known about the patterns of medical cannabis use by patients with chronic pain. This information could help providers anticipate patients’ needs and identify potential disparities in access.

We followed 99 adults in New York State who were newly certified for medical cannabis use and who were prescribed opioids over the course of 1 year. Using a latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.

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Acupuncture for Pain Relief from Chronic Prostatitis and Chronic Pelvic Pain Syndrome

PainRelief.com Interview with:

Zhishun Liu, MD, PhD
Guang’anmen Hospital
China Academy of Chinese Medical Sciences
Beijing, China

acupuncture

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

Response: Pharmacologic therapy has so far failed to reveal universal benefits in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS); the evidence for acupuncture is limited, although it is also recommended in current guidelines.

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