PainRelief.com Interview with: Beth Darnall, PhD Director, Stanford Pain Relief Innovations Lab Associate Professor, Stanford University School of Medicine Department of Anesthesiology, Perioperative and Pain Medicine Psychiatry and Behavioral Sciences (by courtesy) Wu Tsai Neurosciences Institute (affiliate faculty) Palo Alto, CA 94304
Dr. Darnall
PainRelief.com: What is the background for this study? What are the main findings?
Best pain care integrates patient education and tools to help them manage pain and reduce their symptoms1. Multi-session psychological or “behavioral” pain treatment approaches, such as 8-session cognitive behavioral therapy (CBT), are effective for equipping people with pain management skills. However, our prior research showed that patient access to these treatments is often poor, in part due to the costs and time burdens (e.g., up to 16 hours of treatment time).2
Findings from our study suggest that a one-time 2-hour pain relief skills class (“Empowered Relief”) was non-inferior to 8-session CBT for reducing multiple symptoms, including pain catastrophizing, pain intensity, and pain interference at 3 months post-treatment. We also found the single-session pain class imparted substantial reductions for pain bothersome, sleep disturbance, anxiety, fatigue and depression.
PainRelief.com Interview with: Ben Alter, MD, PhD Assistant Professor Director, Translational Pain Research Division of Pain Medicine Department of Anesthesiology and Perioperative Medicine University of Pittsburgh Medical Center
Dr. Ben Alter
PainRelief.com: What is the background for this study? What are the main findings?
Response: In the clinical environment, I am often asking patients where their pain is. There is a large amount of research establishing that widespread or “all-over” pain is difficult to manage and impacts nearly every aspect of a patient’s life. In fact, a tally of body areas is involved with the diagnosis of fibromyalgia, although this is not the only diagnostic criteria. What wasn’t clear to us was whether patterns of pain across the body also impacted important facets of the pain experience.
PainRelief.com Interview with: Mitsuru Mizuno, DVM, Ph.D. Assistant professor at CSCRM, Principal investigator for this study and Ichiro Sekiya, M.D., Ph.D..
PainRelief.com: What is the background for this study? What are the main findings?How are the stem cells obtained?
Response: We have developed a cell therapy for treating difficult-to-heal meniscus injury using mesenchymal stem cells (MSCs) derived from the synovium of the knee. However, trisomy 7 is often found in synovial cells obtained from patients with osteoarthritis, a disease that occurs with aging.
PainRelief.com Interview with: Louise Fleng Sandal PhD Adjunkt, Institut for Idræt og Biomekanik SDU University of Southern Denmark
Dr. Sandal
PainRelief.com: What is the background for this study?
Response:Low back pain is a globally prevalent condition with a high economic cost. Many people seek help with primary care from their general practitioner, physiotherapist or chiropractor. Evidence-based guidelines on first line treatment include learning to self-manage, staying active, exercising and learning about the condition. However, many find this difficult without advice and support, but primary care physicians often lack the time and resources to support self-management.
Digital solutions, such as smartphone technology, utilizing artificial intelligence can be used to tailor self-management support to the individual and be available at the individuals convenience.
Clinical Psychologist | VA Puget Sound, Seattle Staff Psychologist | TelePain Clinic | VISN 20 Pain Medicine & Functional Restoration Center Core Investigator | Health Services Research & Development | Seattle-Denver Center of Innovation Assistant Professor | Department of Psychiatry & Behavioral Sciences University of Washington School of Medicine Seattle, WA 98108
PainRelief.com: What is the background for this study?
Response: Chronic pain affects two-thirds of U.S. military veterans, and nearly 10% of veterans report severe pain that leads to significant distress or impairment. Within the Veterans Health Administration (VHA), interdisciplinary pain management has been the standard of care for high-impact, complex chronic pain, but rural patients are less likely to receive these services.
Telehealth provides an opportunity to address problems with accessing care in rural communities. In 2018, VA Puget Sound launched a regional pain telehealth program, TelePain, to bring interdisciplinary pain care using video telehealth to rural veterans in the Northwest.
In this study, we examined the impact of implementing TelePain on access to pain care among rural patients living in Washington state from 2015-2019 and compared their access to urban patients. All patients had moderate to severe chronic pain, and we included patients with any type of pain (e.g., back, neck, migraines, fibromyalgia, etc.). This study is a retrospective cohort analysis of VA data.
PainRelief.com Interview with: Andrew D. Hershey, MD, PhD, FAAN, FAHS Endowed Chair and Director of Neurology Professor of Pediatrics and Neurology Director, Headache Center Cincinnati Children’s Hospital Medical Center Cincinnati, OH 45229 University of Cincinnati, College of Medicine
PainRelief.com: What is the background for this study?
Response: Migraine is a common and debilitating disease, affecting 1 in 10 children and adolescents worldwide. Refractory migraine in adolescents may be associated with poorer academic performance, reduced school attendance, and a negative effect on social interactions. Current acute treatments for adolescents with migraine are mostly pharmacological. These treatments may cause side effects, and their frequent use may potentially lead to medication overuse headache. Additionally, their efficacy may be variable or inadequate. Thus, there is a great unmet need for new safe and effective acute treatments for adolescents with migraine headaches.
Remote Electrical Neuromodulation (REN) is a non-pharmacological, non-invasive neuromodulatory treatment that has been approved by the US FDA for acute treatment of the headache attacks of migraine in patients 12 years of age or older. The REN device (Nerivio®) is a small stimulator controlled by the user via a smartphone application and activates one of the body’s own pain suppression system by inducing weak electrical currents. These currents stimulate nerve fibers in the upper arm to activate an endogenous descending pain inhibition mechanism termed Conditioned Pain Modulation (CPM). Clinical trials of REN have shown efficacy and safety of the treatment in adolescents 12 and older, as well as in adults.
The current study is the first to compare REN and standard-care treatments (over the counter medications and triptans) in adolescents.
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.
PainRelief.com: What is the background for this study?
Response: We became interested in looking at trunk position during running because one of us (Daniel Lieberman) had anecdotally observed people running with a variety of trunk positions, and when we went looking for academic literature on the topic, we found it was fairly scarce. We suspected that trunk position could have a major impact on the forces experienced by the lower limbs during running and even affect aspects of gait (stride length and time). So we developed a model predicting how these forces and movements might change as trunk flexion/forward leaning increased.
Our primary predictions were that more forward lean would increase “overstride” which is the distance in side view between the hip and the heel as it contacts the ground (a measure of how far your are extending your leg when you step). This in turn would increase the impact forces experienced by the lower limb at initial contact which have previously been shown to increase the risk of repetitive stress injuries. We also predicted that stride would get longer and take more time because extending the leading leg out farther forward (overstriding) would be necessary to keep the body center of mass within a base of support above the limbs. This more extended limb, we predicted, would change the angles and forces about the ankle, knee and hip joints.
PainRelief.com Interview with: Richard L. Nahin, Ph.D., M.P.H Lead Epidemiologist National Center for Complementary and Integrative Health (NCCIH) National Institutes of Health Bethesda, Maryland
Dr. Nahin
PainRelief.com: What is the background for this study?
Response: Individuals of Hispanic ancestry living in the U.S. include numerous subpopulations that vary in the prevalence of chronic disabling conditions, as well as exhibit differences in socioeconomic status, health behaviors, global health status, health care utilization, and genetic profiles.
Despite this evidence, there are few nationally representative studies examining the epidemiology of pain in these Hispanic subpopulations, and none that compared global measures of pain chronicity, severity, nor examined the influence of race on potential associations with pain in Hispanics.
Madeline H. Renny, MD Postdoctoral Fellow, Department of Population Health Clinical Instructor, Department of Emergency Medicine and Pediatrics New York University Grossman School of Medicine New York, New York
Dr. Renny
PainRelief.com: What is the background for this study?
Response: Prescription opioids are involved in over half of opioid overdoses among youth. Additionally, prescription opioid use is associated with risks of future misuse, adverse events, and unintentional exposures by young children. While there are several studies on opioid prescribing in adults, few studies have focused on the pediatric and adolescent population. In the last year, postoperative guidelines for opioid prescribing for children and adolescents were released, but there remain no national guidelines on general opioid prescribing for youth.
To our knowledge, no prior national studies have examined trends in important opioid prescribing practices, including amount prescribed, duration, high-dosage, and extended-release/long-acting (ER/LA) opioid prescriptions, in this subset of the population; a necessary step in understanding the opioid epidemic and in developing targeted interventions for youth.
Therefore, we performed a cross-sectional analysis of U.S. opioid prescription data to investigate temporal trends in several key opioid prescribing practices in children, adolescents, and younger adults in the U.S. from 2006-2018.
PainRelief.com: What are the main findings?
Response: We found that opioid dispensing rates declined significantly for children, adolescents, and younger adults since 2013. When examining trends in opioid prescribing practices, there were differences based on age group. For adolescents and young adults, rates of long-duration and high-dosage opioid prescriptions decreased during the study period, whereas there were increases in these rates for younger children.
PainRelief.com: What should readers take away from your report?
Response: Dispensed opioid prescriptions for youth have significantly decreased in recent years. These findings are consistent with prior studies in children and adults, suggesting that opioid prescribing practices may be improving. Additionally, the decrease in rates of high-dosage and long-duration prescriptions in adolescents and young adults is encouraging in the context of research showing associations with these prescribing practices and opioid use disorder and overdose. However, opioids remain commonly dispensed to youth and potential high-risk prescribing practices (long-duration, high-dosage, and ER/LA prescriptions) appear to be common, especially in younger children.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: The increase in rates of potential high-risk prescribing practices in young children was an unexpected finding and warrants future study. Due to the limitations of our database (no clinical information, including diagnoses or indications for prescription), we were unable to determine the appropriateness of opioid prescribing practices (e.g., whether a prescription was for a child with cancer or for a child with an acute injury). Our two sensitivity analyses were performed to try to identify a subset of patients with chronic illness and both showed no differences in trends. However, it will be important to further investigate these opioid prescribing practices using a database with clinical information to better understand these findings in young children.
Further research investigating specific opioid prescribing practices may inform targeted interventions, including pediatric and adolescent-specific opioid prescribing guidelines, to ensure appropriate opioid prescribing in this population.
No disclosures
Citation:
Renny MH, Yin HS, Jent V, Hadland SE, Cerdá M. Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA Pediatr. Published online June 28, 2021. doi:10.1001/jamapediatrics.2021.1832
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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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